title: Efficacy of radiofrequency ablation compared with transarterial chemoembolization for the treatment of recurrent hepatocellular carcinoma: a comparative survival analysis.
abstract: BACKGROUND
  This study aims to assess if radiofrequency ablation (RFA) has any oncological superiority over transarterial chemoembolization (TACE) on post-hepatectomy recurrence.
  
  
  METHODS
  From 2002 to 2011, 60.15% of 823 patients developed recurrence after hepatectomy for Hepatocellular carcinoma (HCC). 102 patients with recurrence underwent RFA (n = 42) or TACE (n = 60) for tumor size ≤5 cm and number of lesion ≤3 when tumors were not resectable or transplantable. Those with renal impairment, portal vein thrombosis and poor liver reserve were excluded. Primary outcome was overall survival, which was determined using log-rank test and Kaplan Meier plots performed. Categorical data were analyzed using Chi-square test and continuous variable were analyzed using Mann-U Whitney test.
  
  
  RESULTS
  Demographics and primary tumor characteristics were similar in both groups (p > 0.05). Overall survival after initial hepatectomy and salvage treatment for recurrence was similar (p > 0.05) in both groups with 5-year OS after salvage treatment for RFA and TACE at 24.1% and 25.7%, respectively. For patients with second recurrence after salvage treatment, an interchangeable treatment strategy of RFA and TACE conferred a better survival outcome than a stand-alone treatment with RFA or TACE (p < 0.05).
  
  
  CONCLUSIONS
  RFA and TACE may be equally effective for intrahepatic recurrence after hepatectomy when tumor size is ≤5 cm and ≤3 lesion when re-resection or salvage transplantation is not considered feasible.
authors.affiliation: Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong Special Administrative Region; Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Peng S
authors.initials: PS
authors.lastname: Koh
authors.affiliation: Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong Special Administrative Region. Electronic address: acchan@hku.hk.
authors.forename: Albert C Y
authors.initials: AC
authors.lastname: Chan
authors.affiliation: Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong Special Administrative Region.
authors.forename: Tan T
authors.initials: TT
authors.lastname: Cheung
authors.affiliation: Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong Special Administrative Region.
authors.forename: Kenneth S H
authors.initials: KS
authors.lastname: Chok
authors.affiliation: Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong Special Administrative Region.
authors.forename: Wing C
authors.initials: WC
authors.lastname: Dai
authors.affiliation: Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong Special Administrative Region.
authors.forename: Ronnie T P
authors.initials: RT
authors.lastname: Poon
authors.affiliation: Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong Special Administrative Region.
authors.forename: Chung M
authors.initials: CM
authors.lastname: Lo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D017115:Catheter Ablation / Q000009:adverse effects / Q000401:mortality; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects / Q000401:mortality; D016009:Chi-Square Distribution; D016208:Databases, Factual; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local; D016016:Proportional Hazards Models; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D016879:Salvage Therapy; D013997:Time Factors; D016896:Treatment Outcome; D047368:Tumor Burden