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Comparison of radiofrequency ablation and transarterial chemoembolization for hepatocellular carcinoma within the Milan criteria: a propensity score analysis.

Abstract Radiofrequency ablation (RFA) and transarterial chemoembolization (TACE) are used to treat hepatocellular carcinoma (HCC). This study was designed to compare the long-term survival of HCC patients within the Milan criteria who underwent RFA or TACE. In all, 315 RFA patients and 215 TACE patients with HCC within the Milan criteria were analyzed. Propensity scores were generated to select matched patients. For the propensity model, 101 patients were selected from each arm of the study. Independent prognostic predictors were determined with the Cox proportional hazards model. The long-term survival was significantly better for the RFA group in the univariate survival analysis (P = 0.048). In the Cox model, the following were identified as independent predictors of poor prognosis (TACE was not): age > 69 years (P = 0.026), serum α-fetoprotein level > 20 ng/mL (P = 0.003), ascites (P < 0.001), Eastern Cooperative Oncology Group performance status ≥ 1 (P = 0.004), total tumor volume (TTV) > 8.2 cm³ (P = 0.020), and vascular invasion (P = 0.023). With similar baseline patient characteristics generated in the propensity score model, there was no significant difference in the long-term survival rates of the 2 groups of patients. A subgroup analysis showed that among patients with a TTV < 11 cm³, the RFA group had significantly better long-term survival than the TACE group (P = 0.032). In conclusion, TACE and RFA lead to comparable long-term survival rates for HCC patients within the Milan criteria. Patients with a smaller TTV (<11 cm³) are likely to benefit more from RFA treatment. Further studies are needed to compare RFA and TACE in patients with early-stage cancers.
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Journal Title liver transplantation : official publication of the american association for the study of liver diseases and the international liver transplantation society
Publication Year Start




PMID- 21506244
OWN - NLM
STAT- MEDLINE
DCOM- 20110914
LR  - 20110420
IS  - 1527-6473 (Electronic)
IS  - 1527-6465 (Linking)
VI  - 17
IP  - 5
DP  - 2011 May
TI  - Comparison of radiofrequency ablation and transarterial chemoembolization for
      hepatocellular carcinoma within the Milan criteria: a propensity score analysis.
PG  - 556-66
LID - 10.1002/lt.22273 [doi]
AB  - Radiofrequency ablation (RFA) and transarterial chemoembolization (TACE) are used
      to treat hepatocellular carcinoma (HCC). This study was designed to compare the
      long-term survival of HCC patients within the Milan criteria who underwent RFA or
      TACE. In all, 315 RFA patients and 215 TACE patients with HCC within the Milan
      criteria were analyzed. Propensity scores were generated to select matched
      patients. For the propensity model, 101 patients were selected from each arm of
      the study. Independent prognostic predictors were determined with the Cox
      proportional hazards model. The long-term survival was significantly better for
      the RFA group in the univariate survival analysis (P = 0.048). In the Cox model, 
      the following were identified as independent predictors of poor prognosis (TACE
      was not): age &gt; 69 years (P = 0.026), serum alpha-fetoprotein level &gt; 20 ng/mL (P
      = 0.003), ascites (P &lt; 0.001), Eastern Cooperative Oncology Group performance
      status &gt;/= 1 (P = 0.004), total tumor volume (TTV) &gt; 8.2 cm(3) (P = 0.020), and
      vascular invasion (P = 0.023). With similar baseline patient characteristics
      generated in the propensity score model, there was no significant difference in
      the long-term survival rates of the 2 groups of patients. A subgroup analysis
      showed that among patients with a TTV &lt; 11 cm(3), the RFA group had significantly
      better long-term survival than the TACE group (P = 0.032). In conclusion, TACE
      and RFA lead to comparable long-term survival rates for HCC patients within the
      Milan criteria. Patients with a smaller TTV (&lt;11 cm(3)) are likely to benefit
      more from RFA treatment. Further studies are needed to compare RFA and TACE in
      patients with early-stage cancers.
CI  - Copyright (c) 2011 American Association for the Study of Liver Diseases.
FAU - Hsu, Chia-Yang
AU  - Hsu CY
AD  - Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei,
      Taiwan.
FAU - Huang, Yi-Hsiang
AU  - Huang YH
FAU - Chiou, Yi-You
AU  - Chiou YY
FAU - Su, Chien-Wei
AU  - Su CW
FAU - Lin, Han-Chieh
AU  - Lin HC
FAU - Lee, Rheun-Chuan
AU  - Lee RC
FAU - Chiang, Jen-Huey
AU  - Chiang JH
FAU - Huo, Teh-Ia
AU  - Huo TI
FAU - Lee, Fa-Yauh
AU  - Lee FY
FAU - Lee, Shou-Dong
AU  - Lee SD
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Liver Transpl
JT  - Liver transplantation : official publication of the American Association for the 
      Study of Liver Diseases and the International Liver Transplantation Society
JID - 100909185
SB  - IM
MH  - Aged
MH  - Carcinoma, Hepatocellular/*therapy
MH  - Catheter Ablation/*methods
MH  - Chemoembolization, Therapeutic/*methods
MH  - Cohort Studies
MH  - Disease Progression
MH  - Female
MH  - Humans
MH  - Liver Neoplasms/*therapy
MH  - Male
MH  - Middle Aged
MH  - Neoplasm Staging
MH  - Propensity Score
MH  - Proportional Hazards Models
MH  - Treatment Outcome
EDAT- 2011/04/21 06:00
MHDA- 2011/09/15 06:00
CRDT- 2011/04/21 06:00
PHST- 2011/04/21 06:00 [entrez]
PHST- 2011/04/21 06:00 [pubmed]
PHST- 2011/09/15 06:00 [medline]
AID - 10.1002/lt.22273 [doi]
PST - ppublish
SO  - Liver Transpl. 2011 May;17(5):556-66. doi: 10.1002/lt.22273.