Annals of Surgical Oncology

, Volume 21, Issue 12, pp 3835–3843 | Cite as

Survival Advantage of Radiofrequency Ablation Over Transarterial Chemoembolization for Patients with Hepatocellular Carcinoma and Good Performance Status Within the Milan Criteria

  • Po-Hong Liu
  • Yun-Hsuan Lee
  • Chia-Yang Hsu
  • Yi-Hsiang Huang
  • Yi-You Chiou
  • Han-Chieh Lin
  • Teh-Ia Huo
Hepatobiliary Tumors

Abstract

Background

Performance status is closely linked with survival in patients with hepatocellular carcinoma (HCC). We evaluated the impact of performance status on patients with small HCC receiving radiofrequency ablation (RFA) versus transarterial chemoembolization (TACE).

Methods

A total of 424 and 282 patients within the Milan criteria undergoing RFA and TACE, respectively, were analyzed. Patients were classified as performance status 0 (n = 516) and performance status ≥1 (n = 190) groups. A propensity-score matching analysis with preset caliper width was used. A total of 167 and 68 matched pairs were selected from patients with a performance status of 0 and ≥1, respectively.

Results

Radiofrequency ablation provided significantly better long-term survival than TACE for patients within the Milan criteria (p < 0.01). After being stratified by performance status and matched in the propensity model, the baseline characteristics were similar between the RFA and TACE groups for patients with a performance status of 0 or ≥1. RFA provided significantly better long-term survival than TACE in patients with a performance status of 0 in the propensity model (p < 0.05); TACE was significantly associated with 1.784-fold increased risk of mortality (95 % confidence interval 1.075–2.506) by using the Cox proportional hazards model. TACE was not a significant prognostic predictor in patients with a performance status ≥1 in the propensity model.

Conclusions

For HCC patients within the Milan criteria with a performance status of 0, RFA provides better long-term survival than TACE. RFA should be considered a priority treatment in inoperable HCC patients within the Milan criteria. Performance status is a feasible surrogate marker to enhance treatment allocation.

Keywords

Tace Barcelona Clinic Liver Cancer Milan Criterion Tace Group Propensity Model 

Notes

Acknowledgment

This study was supported by Grants from the Center of Excellence for Cancer Research at Taipei Veterans General Hospital, Taiwan (DOH102-TD-C-111-007), Taipei Veterans General Hospital, Taipei, Taiwan (V103C-008), and the Ministry of Education, Aiming for the Top University Plan, Taiwan (103AC-P618).

Disclosures

Po-Hong Liu, Yun-Hsuan Lee, Chia-Yang Hsu, Yi-Hsiang Huang, Yi-You Chiou, Han-Chieh Lin, and Teh-Ia Huo have no conflicts of interest.

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Copyright information

© Society of Surgical Oncology 2014

Authors and Affiliations

  • Po-Hong Liu
    • 1
    • 4
  • Yun-Hsuan Lee
    • 1
    • 4
  • Chia-Yang Hsu
    • 1
    • 4
    • 6
  • Yi-Hsiang Huang
    • 2
    • 4
  • Yi-You Chiou
    • 1
    • 5
  • Han-Chieh Lin
    • 1
    • 4
  • Teh-Ia Huo
    • 1
    • 3
    • 4
  1. 1.Faculty of MedicineNational Yang-Ming University School of MedicineTaipeiTaiwan
  2. 2.Institute of Clinical MedicineNational Yang-Ming University School of MedicineTaipeiTaiwan
  3. 3.Institute of PharmacologyNational Yang-Ming University School of MedicineTaipeiTaiwan
  4. 4.Division of Gastroenterology, Department of MedicineTaipei Veterans General HospitalTaipeiTaiwan
  5. 5.Department of RadiologyTaipei Veterans General HospitalTaipeiTaiwan
  6. 6.Department of BiostatisticsUniversity of California Los AngelesLos AngelesUSA

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