Chemoembolization as an alternative treatment for single, small (≤3 cm) hepatocellular carcinomas with subcapsular location: a propensity score analysis.

BackgroundRadiofrequency ablation (RFA) is a first-line therapy for early-stage, single, small (≤3 cm) hepatocellular carcinoma (HCC) tumors; however, adequate control of subcapsular HCC by RFA remains challenging due to the higher risk of major complications and local tumor recurrence than non-subcapsular HCC.PurposeTo compare safety and efficacy of conventional transarterial chemoembolization (cTACE) and RFA as treatments for single, small (≤3 cm) HCC with a subcapsular location.Material and MethodsBetween 2008 and 2017, 717 treatment-naïve patients who underwent cTACE (n = 362) or RFA (n = 355) as a first-line treatment for single, small (≤3 cm), subcapsular HCC were enrolled. Propensity score analysis using inverse probability weighting (IPW) was applied to reduce the effect of potential confounding factors.ResultsThe median follow-up time was 87 months. After propensity score analysis using IPW, the 15-year overall survival rates in the cTACE and RFA groups were 47% and 45%, respectively (P = 0.89). The 15-year time to local tumor recurrence rates were 55% and 71%, respectively (P <0.001), and the 15-year time to recurrence rates were 29% and 30%, respectively (P = 0.18). The rates of major complication associated with cTACE and RFA after IPW were 1% and 4%, respectively (P = 0.01).ConclusioncTACE is a viable alternative to RFA for treating subcapsular HCCs measuring ≤3 cm, with a comparable overall survival rate and fewer major complications.