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Prognostic impact of transcatheter arterial chemoembolization (TACE) combined with radiofrequency ablation in patients with unresectable hepatocellular carcinoma: Comparison with TACE alone using decision‐tree analysis after propensity score matching
Author(s) -
Shimose Shigeo,
Tanaka Masatoshi,
Iwamoto Hideki,
Niizeki Takashi,
Shirono Tomotake,
Aino Hajime,
Noda Yu,
Kamachi Naoki,
Okamura Shusuke,
Nakano Masahito,
Kuromatsu Ryoko,
Kawaguchi Takumi,
Kawaguchi Atsushi,
Koga Hironori,
Yokokura Yoshinori,
Torimura Takuji
Publication year - 2019
Publication title -
hepatology research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.123
H-Index - 75
eISSN - 1872-034X
pISSN - 1386-6346
DOI - 10.1111/hepr.13348
Subject(s) - propensity score matching , medicine , transcatheter arterial chemoembolization , hepatocellular carcinoma , radiofrequency ablation , gastroenterology , stage (stratigraphy) , liver cancer , retrospective cohort study , ablation , paleontology , biology
Aims The prognosis of hepatocellular carcinoma (HCC) patients treated with transcatheter arterial chemoembolization (TACE) is still poor. We aimed to evaluate the impact of TACE combined with radiofrequency ablation (TACE+RFA) on the prognosis of HCC patients using decision‐tree analysis after propensity score matching. Methods This was a retrospective study. We enrolled 420 patients with HCC treated with TACE alone ( n = 311) or TACE+RFA ( n = 109) between 1998 and 2016 (median age, 72 years; male / female, 272/148; Barcelona Clinic Liver Cancer (BCLC) stage A / B, 215/205). The prognosis of patients who underwent TACE+RFA was compared to patients who underwent TACE alone after propensity score matching. Decision‐tree analysis was used to investigate the profile for prognosis of the patients. Results After propensity score matching, there was no significant difference in age, sex, BCLC stage, or albumin–bilirubin (ALBI) score between both groups. The survival rate of the TACE+RFA group was significantly higher than the TACE alone group (median survival time [MST] 57.9 months vs. 33.1 months, P < 0.001). In a stratification analysis according to BCLC stage, the overall survival rate of the TACE+RFA group was significantly higher than the TACE alone group in BCLC stage A and B (MST 57.9 and 50.7 months vs. 39.8 and 24.5 months [ P = 0.007 and 0.001], respectively). Decision‐tree analysis showed that TACE+RFA was the third distinguishable factor for survival in patients with α‐fetoprotein level >7 ng/mL and ALBI <−2.08. Conclusion Decision‐tree analysis after propensity score matching showed that TACE+RFA could prolong the survival of HCC patients compared to TACE alone.