Propensity score analysis is a reliable method to estimate the effects of treatments or interventions from analyses of large
observational databases. The study was designed to retrospectively compare combined transarterial chemoembolization (TACE) and
CT-guided radiofrequency ablation (RFA) with TACE alone for the treatment of hepatocellular carcinoma (HCC) beyond the Milan
criteria with the propensity score analysis.
Materials & Methods:
204 patients with HCC beyond the Milan criteria underwent lipiodol-based TACE treatments (TACE group) and
122 ones underwent TACE + CT-guided RFA (TACE + RFA group) were analyzed. With the baseline differences adjusted by propensity
score analysis, 103 matched pairs of HCC patients were selected from each treatment group. Long-term survival rate was evaluated by
the Kaplan-Meier method. Independent prognostic predictors were determined with the Cox proportional hazards model.
For the propensity model, 103 patients were selected from each arm of the study. In the propensity score analysis, the 1-, 3-,
and 5-year overall survival rates for selected patients were 51.5%, 13.6%, and 2.9%, respectively, for TACE group and 90.2%, 45.6%, and
12.6%, respectively for TACE+RFA group (P< 0.01). The 1-, 3-, and 5-year progression free survival (PFS) rates were 19.0%, 5.5%, and
0% for the TACE group and 45.2%, 17.5%, and 4.2% for the TACE+RFA group (P< 0.001). Patients receiving TACE alone had significant
risk for severe hepatic dysfunction (P<0.01) and less severe hemorrhage (P< 0.01) compared to patients in the TACE+RFA group. The
vascular invasion, lesion counts ≥3, ECOG ≥0 and the Child-Pugh class B were analyzed as the prognostic factors.
TACE combined with CT-guided RFA provides better survival benefits for patients with HCC beyond the Milan criteria
than TACE alone.
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