title: Survival with up to 10-year follow-up after combination therapy of chemoembolization and radiofrequency ablation for the treatment of hepatocellular carcinoma: single-center experience.
abstract: OBJECTIVE
  To report 10-year outcomes of treating hepatocellular carcinomas (HCCs) by combination therapy of chemoembolization and radiofrequency (RF) ablation.
  
  
  METHODS
  Combination therapy was administered in 277 patients with 382 treatment-naïve HCCs. Therapeutic effects, safety, survival rate, and prognostic factors were evaluated.
  
  
  RESULTS
  Tumor enhancement disappeared after 466 RF sessions in all tumors, resulting in a complete response rate of 100% (277 of 277) based on modified Response Evaluation Criteria In Solid Tumors. Local tumor progression developed in 15 patients (5.4%; 15 of 277) during the mean follow-up of 44.9 months±29.1 (range, 6.0-134.4 mo). Overall and recurrence-free survival rates were 56.3% (95% confidence interval [CI], 52.5%-60.2%) and 22.5% (95% CI, 19.3%-25.6%) at 5 years and 23.5% (95% CI, 17.7%-29.2%) and 9.3% (95% CI, 6.3%-12.4%) at 10 years. The Child-Pugh class was the only significant prognostic factor detected in both the univariate (P<.001) and the multivariate analyses (hazard ratio, 3.8; 95% CI, 2.5-5.6; P<.001). The 5-year and 10-year overall survival rates were 66.4% (95% CI, 62.0%-70.8%) and 30.6% (95% CI, 23.3%-37.9%) in 210 Child-Pugh class A patients. In addition to the Child-Pugh class, the maximum tumor diameter (≤3 cm vs>3 cm) and the tumor number (single vs multiple) were significant independent factors affecting recurrence-free survival. No death was related to the combination therapy. The major complication rate was 3.2% (15 of 466).
  
  
  CONCLUSIONS
  RF ablation combined with chemoembolization is a safe and useful therapeutic option for treating HCCs. Prognostic factors detected in this study help to stratify patients who benefit from this combination therapy.
authors: Department of Radiology, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan. fujimorim@clin.medic.mie-u.ac.jp
authors: Masashi
authors: M
authors: Fujimori
authors: Haruyuki
authors: H
authors: Takaki
authors: Atsuhiro
authors: A
authors: Nakatsuka
authors: Junji
authors: J
authors: Uraki
authors: Takashi
authors: T
authors: Yamanaka
authors: Takaaki
authors: T
authors: Hasegawa
authors: Katsuya
authors: K
authors: Shiraki
authors: Yoshiyuki
authors: Y
authors: Takei
authors: Hajime
authors: H
authors: Sakuma
authors: Koichiro
authors: K
authors: Yamakado
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000401:mortality* / Q000628:therapy*; D017115:Catheter Ablation / Q000401:mortality*; D016461:Chemoembolization, Therapeutic / Q000401:mortality*; D003131:Combined Modality Therapy / Q000401:mortality*; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008113:Liver Neoplasms / Q000401:mortality* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D018570:Risk Assessment; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome