Outcomes of transarterial chemoembolization plus percutaneous radiofrequency ablation for early-stage hepatocellular carcinoma with tumor diameter > 3 cm versus ≤ 3 cm: a single-center retrospective study

Background/objective To investigate the effectiveness and safety of transarterial chemoembolization (TACE) plus percutaneous radiofrequency ablation (pRFA) (TACE-pRFA) for very early/early-stage hepatocellular carcinoma (HCC) with tumor diameters >3 cm versus ≤ 3 cm. Methods In this retrospective study, we enrolled 118 patients who underwent TACE-pRFA for a single HCC (≤ 5 cm) from February 2014 to December 2021. Patients were divided into two groups according to the maximum tumor diameter (≤ 3 cm versus > 3 cm). Regular follow-up was conducted after pRFA to assess progression-free survival (PFS). TACE-pRFA-related complications were evaluated. Univariable and multivariable Cox proportional-hazards regression analyses were performed to identify risk factors for PFS. Results The median PFS of the total cohort was 35.0 months (95% confidence interval [CI], 24.3–45.7). The 1-, 3-, and 5-year cumulative PFS rates in the whole cohort were 84.7% (95% CI, 78.1–91.9%), 47.5% (95% CI, 38.2–59.0%), and 31.5% (95% CI, 22.2–44.9%), respectively. Univariable and multivariable analyses showed that the maximum tumor diameter (p = 0.023) was an independent prognostic factor for PFS after TACE-pRFA. Treatment-related complications were comparable between the ≤ 3 cm group and the > 3 cm group. Conclusion TACE combined with pRFA is safe for very early/early-stage single HCC ≤5 cm. Maximum tumor diameter is an independent prognostic factor for PFS, while treatment-related complications are comparable between tumors ≤3 cm and >3 cm.