title: Radiofrequency ablation with or without transcatheter arterial chemoembolization in the treatment of hepatocellular carcinoma: a prospective randomized trial.
abstract: OBJECTIVE
  To compare radiofrequency ablation (RFA) with or without transcatheter arterial chemoembolization (TACE) in the treatment of hepatocellular carcinoma (HCC).
  
  
  METHODS
  A randomized controlled trial was conducted on 189 patients with HCC less than 7 cm at a single tertiary referral center between October 2006 and June 2009. Patients were randomly asssigned to receive TACE combined with RFA (TACE-RFA; n = 94) or RFA alone (n = 95). The primary end point was overall survival. The secondary end point was recurrence-free survival, and the tertiary end point was adverse effects.
  
  
  RESULTS
  At a follow-up of 7 to 62 months, 34 patients in the TACE-RFA group and 48 patients in the RFA group had died. Thirty-three patients and 52 patients had developed recurrence in the TACE-RFA group and RFA group, respectively. The 1-, 3-, and 4-year overall survivals for the TACE-RFA group and the RFA group were 92.6%, 66.6%, and 61.8% and 85.3%, 59%, and 45.0%, respectively. The corresponding recurrence-free survivals were 79.4%, 60.6%, and 54.8% and 66.7%, 44.2%, and 38.9%, respectively. Patients in the TACE-RFA group had better overall survival and recurrence-free survival than patients in the RFA group (hazard ratio, 0.525; 95% CI, 0.335 to 0.822; P = .002; hazard ratio, 0.575; 95% CI, 0.374 to 0.897; P = .009, respectively). There were no treatment-related deaths. On logistic regression analyses, treatment allocation, tumor size, and tumor number were significant prognostic factors for overall survival, whereas treatment allocation and tumor number were significant prognostic factors for recurrence-free survival.
  
  
  CONCLUSIONS
  TACE-RFA was superior to RFA alone in improving survival for patients with HCC less than 7 cm.
authors.affiliation: State Key Laboratory of Oncology in Southern China, Guangzhou, PR China.
authors.forename: Zhen-Wei
authors.initials: ZW
authors.lastname: Peng
authors.forename: Yao-Jun
authors.initials: YJ
authors.lastname: Zhang
authors.forename: Min-Shan
authors.initials: MS
authors.lastname: Chen
authors.forename: Li
authors.initials: L
authors.lastname: Xu
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: Ya-Qi
authors.initials: YQ
authors.lastname: Zhang
authors.forename: Wan Yee
authors.initials: WY
authors.lastname: Lau
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000401:mortality / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D017115:Catheter Ablation / Q000009:adverse effects; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects; D002681:China; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000097:blood / Q000401:mortality / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D011446:Prospective Studies