Therapeutic efficacy of transarterial chemoembolization-radiofrequency ablation combination in hepatocellular carcinoma with a high tumor burden

Objective To evaluate the therapeutic efficacy of the transarterial chemoembolization (TACE)-radiofrequency ablation (RFA) combination in advanced hepatocellular carcinoma (HCC) with a high tumor burden and analyze the clinical factors influencing its efficacy. Methods This study performed a retrospective analysis of general data, underlying conditions (hypertension, diabetes, and coronary heart disease), tumor-related indicators (tumor size, number of tumors, tumor distribution, presence of capsule, Chinese Liver Cancer stages, and Barcelona Clinic Liver Cancer stages), clinical laboratory indicators (such as liver and renal function parameters, coagulation parameters, routine blood count, hepatitis B virus DNA presence, and alpha-fetoprotein) affecting postoperative efficacy and 5-year survival outcomes in patients with advanced HCC who underwent TACE-RFA combination treatment from November 2017 to November 2022 at the General Hospital of Ningxia Medical University. The efficacy was evaluated based on modified Response Evaluation Criteria in Solid Tumors. This study included 94 patients (79 males and 15 females) with a mean age of 52.27 ± 10.26 years. Results No severe postoperative complications were noted in patients. The median progression-free survival was 14.88 months. The complete response rates at 1, 3, 6, and 12 months were 100%, 90%, 78%, and 57%, respectively. The 1-year, 2-year, 3-year, and 5-year survival rates were 86%, 35%, 11%, and 3%, respectively. Tumor with a diameter of > 5 cm, tumor in the left liver lobe, and aberrant cholinesterase activity decreased the progression-free survival. Prothrombin activity (PTA) was a potential risk factor for prognosis (P < 0.05). Prothrombin time (PT) was a key factor influencing patient survival. Patients with elevated blood urea nitrogen levels exhibited decreased overall survival. Conclusion The TACE-RFA combination is effective in improving lesion control and survival rates in patients with large or multiple HCC tumors. Tumor location, serum cholinesterase, PT activity, and blood urea nitrogen are potential predictive indicators for evaluating the prognosis of patients with advanced HCC undergoing TACE-RFA combination treatment.