Combined resection and radiofrequency ablation versus transarterial embolization for intermediate-stage hepatocellular carcinoma: A propensity score matching study.

Objective: This study aimed to compare the outcomes of combined hepatic resection (HR) plus intraoperative radiofrequency ablation (RFA) and transarterial embolization (TAE) for Barcelona Clinic Liver Cancer (BCLC) stage B hepatocellular carcinoma (HCC) in case-controlled patient groups using the propensity score.

Methods: A total of 179 patients with multifocal HCC treated with HR plus RFA (n = 26) or TAE (n = 153) were retrospectively studied. All patients were classified as BCLC stage B and Child-Pugh class A. Analyses were performed over all participants as well as for propensity score-matched (1:3) patients to adjust for baseline differences. Cumulative overall survival (OS) and time to progression (TTP) were compared between the two groups using the Kaplan-Meier method, and independent predictors were identified by multivariate Cox regression analysis.

Results: Patients treated with HR plus RFA had better OS and longer TTP than those with TAE (p = 0.011 and p < 0.001, respectively). Multivariate Cox regression analysis showed that combined therapy (hazard ratio 0.31; 95% confidence interval (CI), 0.12-0.78; p = 0.013), BCLC substage B2 (hazard ratio 1.82; 95% CI, 1.13-2.92; p = 0.013) and alpha-fetoprotein ≥ 400 ng/ml (hazard ratio 1.85; 95% CI, 1.12-3.05; p = 0.016) were independent factors associated with OS. After propensity score matching, combined therapy was the significant factor associated with OS and TTP by univariate and multivariate analyses.

Conclusions: Combined HR plus RFA may provide survival advantage compared to TAE in patients with BCLC stage B HCC.