J Korean Med Sci.  2023 Oct;38(42):e362. 10.3346/jkms.2023.38.e362.

Drug-Eluting Bead Transarterial Chemoembolization Versus Radiofrequency Ablation as an Initial Treatment of Single Small (≤ 3 cm) Hepatocellular Carcinoma

• Lee S
• Jeong YY
• Lee BC
• Shin SS
• Heo SH
• Kim HO
• Park C
• Jeong WG

• KMID: 2547563
• DOI: http://doi.org/10.3346/jkms.2023.38.e362

Abstract

Background
In this study, we aimed to compare the long-term therapeutic outcomes of drug-eluting bead transarterial chemoembolization (DEB-TACE) with those of radiofrequency ablation (RFA) for the initial treatment of a single small (≤ 3 cm) hepatocellular carcinoma (HCC).
Methods
From January 2010 to December 2021, 259 consecutive patients who underwent DEB-TACE (67 patients) or RFA (192 patients) as a first-line treatment for a single small HCC were enrolled in this retrospective study. The therapeutic outcomes, including cumulative intrahepatic local tumor progression (LTP), progression-free survival (PFS), and longterm overall survival (OS) rates, were compared between the two groups before and after propensity score (PS) matching. Multivariate Cox proportional hazard models were used to evaluate the prognostic factors and differences in OS and PFS between the two groups for all 92 patients after PS matching.
Results
After PS matching, the 1-, 2-, 3-, and 5-year LTP rates were lower in the RFA group than those in the DEB-TACE group (P < 0.001), and the 1-, 2-, 3-, and 5-year PFS rates in the RFA group were higher than those in the DEB-TACE group (P = 0.007). However, the 1-, 2-, 3-, and 5-year OS rates were not significantly different between the RFA and DEB-TACE groups (P = 0.584). Moreover, the OS was not significantly different between the RFA and DEB-TACE groups in the univariate and multivariate analyses, with a hazard ratio (HR) of 0.81. The PFS was significantly higher in the RFA group than that in the DEB-TACE group in the univariate analyses, with a HR of 0.44 (P = 0.009). Multivariate Cox regression analysis showed that albumin (P = 0.019) was an independent prognostic factor for OS. Additionally, the major complication rates were not significantly different between the DEB-TACE and RFA groups (P = 1.000).
Conclusion
The LTP and PFS rates of RFA were superior to those of DEB-TACE in the initial treatment of single small HCC after PS matching. However, the OS rates were not significantly different between RFA and DEB-TACE. Therefore, DEB-TACE may be considered an efficient substitute for RFA in some patients with a single small HCC who are ineligible for RFA.

Keyword

Hepatocellular Carcinoma; Radiofrequency Ablation; Drug-Eluting Bead Transarterial Chemoembolization

Figure

• 

  Fig. 1 Flow diagram of the patient selection for the study.DEB-TACE = drug-eluting bead transarterial chemoembolization, RFA = radiofrequency ablation, HCC = hepatocellular carcinoma, ECOG = Eastern Cooperative Oncology Group.

• 

  Fig. 2 LTP, PFS, and OS rates between the DEB-TACE and RFA groups in all 259 patients before propensity score matching. The (A) cumulative LTP, (B) PFS, and (C) OS rates were significantly better in the RFA group than in the DEB-TACE group. The (D) IDR rates showed no significant difference between the two groups.DEB-TACE = drug-eluting bead transarterial chemoembolization, RFA = radiofrequency ablation, LTP = local tumor progression, PFS = progression-free survival, OS = overall survival, IDR = intrahepatic distant recurrence.

• 

  Fig. 3 LTP, PFS, and OS rates between the DEB-TACE and RFA groups in all 92 patients after propensity score matching. The (A) cumulative LTP and (B) PFS rates were significantly better in the RFA group than in the DEB-TACE group. The (C) OS and (D) IDR rates were not significantly different between the two groups.DEB-TACE = drug-eluting bead transarterial chemoembolization, RFA = radiofrequency ablation, LTP = local tumor progression, PFS = progression-free survival, OS = overall survival, IDR = intrahepatic distant recurrence.

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