title: Recurrent hepatocellular carcinoma treated with sequential transcatheter arterial chemoembolization and RF ablation versus RF ablation alone: a prospective randomized trial.
abstract: OBJECTIVE
  To compare prospectively the effects of radiofrequency (RF) ablation after transcatheter arterial chemoembolization (TACE) with those of RF ablation alone in the treatment of recurrent hepatocellular carcinoma (HCC).
  
  
  METHODS
  This study was approved by the institutional ethics committee, and all patients gave written informed consent. From January 2002 to December 2006, 139 patients with recurrent HCC measuring 5 cm in diameter or smaller were randomized to receive either sequential TACE and RF ablation (sequential treatment group, n=69) or RF ablation alone (RF ablation group, n=70). The survival curves were constructed with the Kaplan-Meier method and compared by using the log-rank test. Bonferroni correction was applied when multiple comparisons were performed. P<.0083 (.05÷6) was considered indicative of a statistically significant difference.
  
  
  RESULTS
  The 1-, 3-, and 5-year overall survival rates were 94%, 69%, and 46%, respectively, for the sequential treatment group and 82%, 47%, and 36% for the RF ablation group (P=.037). The corresponding recurrence-free survival rates were 80%, 45%, and 40% for the sequential treatment group and 64%, 18%, and 18% for the ablation group (P=.005). At subgroup analyses, the overall survival for the sequential treatment group was better than that for the RF ablation group for patients with tumor recurrence 1 year or less after initial treatment (P=.004) and those with tumors measuring 3.1-5.0 cm (P=.002) but not for those with tumor recurrence more than 1 year after initial treatment (P=.421) and those with tumors 3.0 cm or smaller (P=.478). The recurrence-free survival in the sequential treatment group was better than that in the RF ablation group for patients with tumors measuring 3.1-5.0 cm (P<.001) but not for those with tumors 3.0 cm or smaller (P=.204). For recurrence-free survival, there was no significant difference between the two groups for patients with tumor recurrence 1 year or less or more than 1 year after initial treatment (P=.020 and P=.111, respectively). Logistic regression analysis showed that treatment allocation and the interval between initial treatment and tumor recurrence were significant prognostic factors for overall survival, whereas the interval between initial treatment and tumor recurrence, treatment allocation, and tumor size were significant prognostic factors for recurrence-free survival.
  
  
  CONCLUSIONS
  The efficacy of sequential TACE-RF ablation is better than that of RF ablation alone for recurrent HCC.
authors.affiliation: Department of Hepatobiliary Surgery, Cancer Centre of Sun Yat-sen University, and The Second Affiliated Hospital of Guangzhou Medical College, 651 Dongfeng Rd East, Guangzhou 510060, China.
authors.forename: Zhen-Wei
authors.initials: ZW
authors.lastname: Peng
authors.forename: Yao-Jun
authors.initials: YJ
authors.lastname: Zhang
authors.forename: Hui-Hong
authors.initials: HH
authors.lastname: Liang
authors.forename: Xiao-Jun
authors.initials: XJ
authors.lastname: Lin
authors.forename: Rong-Ping
authors.initials: RP
authors.lastname: Guo
authors.forename: Min-Shan
authors.initials: MS
authors.lastname: Chen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000628:therapy*; D017115:Catheter Ablation / Q000706:statistics & numerical data*; D016461:Chemoembolization, Therapeutic / Q000706:statistics & numerical data*; D002681:China / Q000453:epidemiology; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000628:therapy*; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult