Radiofrequency ablation with or without conventional transarterial chemoembolization for subcapsular versus nonsubcapsular hepatocellular carcinoma within Milan criteria: a propensity score-matched study.

Abstract

Objective: Our study was to compare the therapeutic outcomes of radiofrequency ablation (RFA) with or without conventional transarterial chemoembolization (cTACE) for hepatocellular carcinoma (HCC) within Milan criteria in subcapsular versus nonsubcapsular locations by using propensity score matching.

Materials and methods: This retrospective study included 171 consecutive HCC patients meeting Milan criteria who initially received RFA with or without cTACE at a tertiary academic center between January 2017 to December 2022. Technical success rate, progression-free survival (PFS) were recorded. Factors predicting PFS after RFA with or without cTACE were investigated through a Cox proportional hazard model.

Results: The cumulative 1-, 3-, and 5-year PFS were 73.9%%, 27.7%%, and 7.7%, respectively. The cumulative PFS rates were 76.1% and 17.3% at 1 and 3 years, respectively, in the subcapsular group and 71.8% and 37.2% in the nonsubcapsular group (p = 0.034). Matching yielded 49 matched pairs of patients. In the matched group, corresponding cumulative PFS rates were 75.6% and 14.6% at 1 and 3 years, respectively, in the subcapsular group and 69.6% and 30.2% in the nonsubcapsular group (p = 0.156). Multivariate analysis confirmed that subcapsular tumor location was not an independent risk factor for PFS. Additionally, differences in technical success rate were not significant between groups.

Conclusion: The differences in PFS rates and technical success rate in HCC patients within the Milan criteria who received RFA with or without cTACE were not significant between the subcapsular and non-subcapsular groups. Future larger prospective multicenter trials are needed to validate these findings.