Clinical Study Of Transarterial Chemoembolization And Radiofrequency Ablation For Recurrent Hepatocellular Carcinoma

Objective:There is no consensus on the treatment decision for recurrent hepatocellular carcinoma.We analyzed the perioperative data and follow-up results of hepatic artery embolization chemotherapy and radiofrequency ablation for the treatment of recurrent hepatocellular carcinoma with inhepatic recurrence after radical resection.Exploring the long-term prognosis and prognostic factors affecting overall survival,in order to provide experience for the choice of treatment options.Method:From January 1,2011 to October 1,2017,a total of 55 patients with recurrent hepatocellular carcinoma were included.Among them,23 patients with radiofrequency ablation(mean tumor size 2.635±1.2521cm)33 patients(mean tumor size 3.159±2.3464 cm)were treated with hepatic artery embolization.The primary outcome was overall survival(OS).Kaplan-Meier method was used to construct survival curves,which were compared by log-rank test.Categorical data were analysed using the chi-square test and continuous variable were analysed using the T-test.Prognostic factors for OS were analyzed using univariate and multivariate Cox proportional hazard models.Result:1.The 1-year,2-year,3-year,4-year,and 5-year cumulative survival rates for hepatic artery embolization chemotherapy and radiofrequency ablation were 65.6%,34.4%,18.8%,3.1%,0,and 65.2%,and 47.8%,respectively.,30.4%,21.7%,13.0%.There was no statistical difference in overall survival between the two groups.2.Univariate analysis showed lymphocyte count(RR: 0.754;95% CI: 0.340-1.671;P = 0.0487),AST(RR: 1.020;95% CI: 1.004-1.035;P = 0.012),ALB(RR: 0.837;95% CI: 0.760-0.922;P = 0.000330),Child-Pugh classification(RR: 0.158;95% CI: 0.03-0.709;P = 0.016),AFP index at relapse(RR: 1.000;95% CI: 1.000-1.000;P=0.001),diameter of tumor at the time of initial diagnosis(RR: 1.195;95% CI: 1.062-1.344;P=0.003),degree of differentiation(P=0.020),poor differentiation(RR: 5.026;95%;CI: 1.498-16.866;P=0.009),microvascular invasion(RR: 0.592;95% CI: 0.369-0.948;P=0.029),TNM staging(P=0.013),and maximum tumor diameter at recurrence(RR: 1.359;95%;CI:1.086-1.700;P=0.007),the number of tumor lesions at recurrence(RR: 2.199;95% CI: 1.447-3.344;P=0.000227),and whether major complications occurred(RR: 0.075;95% CI: 0.018-0.305;P=0.000295)was significantly associated with overall survival.3.Multivariate analysis showed ALB(RR:0.667;95%CI:0.483-0.921;P=0.014),Child-pugh grade(RR: 0.000051;95% CI: 0.000-.040;P=0.004),tumor diameter at initial onset(RR: 0.494;95% CI: 0.265-0.922;P=0.027),whether it meets the Milan criteria(RR: 0.005;95% CI: 0.000072-.301;P = 0.012)at the time of initial diagnosis,and the time interval for recurrence is less than or equal to 12 months;the index of AFP at relapse(RR: 1.001;95% CI :1.000 to 1.001;P=0.003),maximum tumor diameter at recurrence(RR: 1.992;95% CI: 1.03 to 3.842;P=0.040),number of tumor lesions at recurrence(RR: 23.302: 95% CI: 3.615-150.219;P=0.001)is an independent prognostic factor for overall survival.Conclusion:1.For patients with recurrent liver cancer,there was no significant difference in overall survival between TACE and RFA.2.Serum albumin,Child-pugh classification,diameter of the tumor at the time of first diagnosis,whether it met the Milan criteria at the time of initial diagnosis,interval of recurrence less than or equal to 12 months,index of AFP at relapse,maximum diameter of tumor at recurrence,recurrence of tumor lesion The number is a significant independent prognostic factor that affects overall survival.3.RFA is suitable for recurrent liver cancer that is not suitable for surgical resection,tumor diameter ≤3cm,and tumor number of 3 to 5.RFA has good reproducibility.4.TACE is applicable to recurrent hepatocellular carcinoma that is not suitable for surgical resection,RFA,and a single tumor with a diameter of >5cm.The implementation of TACE is limited by the tumor blood supply.