Survival Benefits of Transarterial Chemoembolization Plus Ablation Therapy in Patients With Intermediate or Advanced Hepatocellular Carcinoma: A Propensity Score Matching Study

Jingyi Dai,1,2 Yadi Ding,1 Qiaomei Zheng,1 Guixin Zhao,1 Lingqing Zou,1 Jun Zhao,3 Yu Luo,4,* Virasakdi Chongsuvivatwong5,* 1Department of Public Laboratory, The Third People’s Hospital of Kunming/Infectious Disease Clinical Medical Center of Yunnan Province, Kunming, Yunnan, People’s Republic of China; 2International Research Fellow, Prince of Songkla University, Hat Yai, Songkhla, Thailand; 3School of Public Health, Hubei University of Medicine, Shiyan, Hubei, People’s Republic of China; 4Department of Oncology, The Third People’s Hospital of Kunming, Kunming, Yunnan, People’s Republic of China; 5Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand*These authors contributed equally to this workCorrespondence: Yu Luo, Department of Oncology, The Third People’s Hospital of Kunming, Kunming, Yunnan, People’s Republic of China, Email [email protected] Virasakdi Chongsuvivatwong, Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand, Email [email protected]: To evaluate the survival outcomes of patients with intermediate to advanced hepatocellular carcinoma (HCC), patients who underwent transarterial chemoembolization (TACE) alone were compared with those who underwent a combination of TACE and ablation therapy.Patients and Methods: This study retrospectively evaluated 536 HCC patients in our hospital from July 2016 to November 2022. All patients underwent TACE, with a subset also receiving ablation therapy. To ensure comparability, propensity score matching (PSM) was performed. We then compared overall survival (OS) and progression-free survival (PFS) between these two groups. Survival outcomes were analyzed utilizing Kaplan-Meier curves and compared via the Cox regression.Results: 200 among these 536 HCC patients received TACE combined with ablation whereas the remaining 336 received TACE alone. With PFS analysis, the numbers were reduced to 176 in combination therapy group and 250 in TACE alone group. With and without PSM, the OS and PFS were consistently and significantly better in the former than the latter group. In patients with Barcelona Clinic Liver Cancer (BCLC) stage B or C, those who received combination therapy demonstrated significantly higher OS compared to those treated with TACE alone. For stage B patients, PFS was also significantly longer in the combination therapy group, before and after PSM [hazard ratio (HR), 0.563; 95% CI: 0.360– 0.879; P = 0.012, HR, 0.613; 95% CI: 0.382– 0.985; P = 0.043]. However, after PSM, no statistical difference in survival outcomes was observed between the two groups for stage C patients (HR, 0.673; 95% CI: 0.395– 1.146; P = 0.145).Conclusion: Our data suggested that for OS, the combination therapy has sustained benefits for both patients with stage B and C, But for PFS, the benefits of the combination therapy among the stage C patients, could not be persistently demonstrated by the current datasets.Keywords: hepatocellular carcinoma, transarterial chemoembolization, ablation, overall survival, progression free survival