Clinical effect of transcatheter arterial chemoembolization combined with local thermal ablation in treatment of large hepatocellular carcinoma and related influencing factors

Objective To investigate the clinical effect of transcatheter arterial chemoembolization (TACE) combined with local thermal ablation in the treatment of large hepatocellular carcinoma (HCC) .Methods A retrospective analysis was performed for the clinical data of134 patients with large HCC who underwent TACE combined with local thermal ablation in our center from January 2010 to September 2016.In all patients, 75 underwent TACE combined with microwave ablation and 59 underwent TACE combined with radiofrequency ablation.The effect of ablation (complete ablation and partial ablation) was evaluated, and follow-up was performed to observe the recurrence of intrahepatic tumor in patients with complete ablation.The chi-square test and logistic regression analysis were used to evaluate the influencing factors for the effect of ablation, and the Kaplan-Meier survival analysis and the Cox proportional hazards model were used to analyze recurrence-free survival and related influencing factors.Results Of all patients, 88 achieved complete ablation and 46 patients achieved partial ablation, resulting in a complete ablation rate of 65.7%.The logistic regression analysis showed that presence of portal vein tumor thrombus (odds ratio[OR]=5.051, P=0.017) , incomplete tumor capsule (OR=4.199, P=0.007) , and dangerous location of tumor (OR=4.967, P=0.001) were independent risk factors for the effect of ablation.The patients with complete ablation had a median recurrencefree survival of 17.41±2.73 months and the 1-, 3-, and 5-year recurrence-free survival rates were 61.4%, 23.3%, and 17.7%, respectively;the multivariate analysis showed that multiple tumors (OR=1.708, P=0.041) was an independent risk factor.There were no significant differences between TACE combined with microwave ablation and TACE combined with radiofrequency ablation in the effect of ablation (χ2=2.431, P=0.119) and tumor recurrence (χ2=3.292, P=0.070) .ConclusionPresence of portal vein tumor thrombus, tumor capsule integrity, and tumor location are important influencing factors for the effect of ablation in patients with large HCC.For patients with complete ablation, the number of tumors can be used to assess the risk of intrahepatic tumor recurrence.