Transarterial Chemoembolization Plus Ultrasound/CT-Guided Radiofrequency Ablation and Iodine-125 Seed Implantation for Hepatocellular Carcinoma in High-Risk Locations:A Clinical Analysis
Objective To analyze the efficacy,complications,and prognosis factors of transarterial chemoembolization(TACE)plus ultrasound/CT-guided radiofrequency ablation(RFA)and iodine-125(125I)seed implantation(TACE-RFA-125I)for hepatocellular carcinoma(HCC)in high-risk locations.Methods The clinical data of patients with unre-sectable HCC(≤5 cm)in high-risk locations,who received the TACE-RFA-125I treatments in our hospital,were collected.The RFA and 125I seed implantation procedures were performed under ultrasound plus CT guidance.The efficacy,complica-tions,and prognosis factors of these patients were analyzed.Results Fifty-sixpatients were included with follow-up of 17-123 months and 33 patients(58.9％)experienced the tumor recurrences.Among the tumor recurrence patients,9 pa-tients(16.1％)occurred a local tumor recurrence,and the intrahepatic distant tumor recurrence and extrahepatic tumor metastasis were occurred in 24 patients(42.9％).The 1-,2-,3-,4-,and 5-year local tumor recurrence rates were 0％,9.1％,13.9％,13.9％,and 17.5％,respectively,and the 1-,2-,3-,4-,and 5-year overall tumor recurrence rates were 1.8％,23.6％,37.7％,54.1％,and 61.6％,respectively.The univariate and multivariate analyses showed that the tumor size≤3 cm was a protective factor for the local and overall tumor recurrences(P=0.009,P＜0.001).The 1-,2-,3-,4-,and 5-year local tumor progression-free survival rates of patients were 100％,85.6％,72.5％,67.2％,and 56.0％,respec-tively,and the overall tumor progression-free survival rates were 98.2％,71.2％,55.8％,39.2％,and 33.6％.The univa-riate and multivariate analyses showed that the tumor size≤3 cm was a protective factor for the local tumor progression-free survival and overall tumor progression-free survival time(P=0.015,P=0.002).The 1-,2-,3-,4-,and 5-year overall sur-vival rates of patients were 100.0％,94.6％,81.9％,76.7％,and 64.8％,respectively.The univariate and multivariate analyses showed that a single tumor lesion and BCLC stage A of HCC were the protective factors for overall survival(P=0.016,P=0.009).All the TACE,RFA,and iodine-125 seed implantation procedures were successfully performed without occurrences of major complications or deaths.Conclusion TACE-RFA-125I should be an ideal treatment strategy for unre-sectable HCC(≤5 cm)in high-risk locations,and it is worthy of clinical promotion and application.
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