Clinical effect of transcatheter arterial chemoembolization combined with radiofrequency ablation in treatment of Barcelona Clinical Liver Cancer stage B primary liver cancer and influencing factors for prognosis

Objective To investigate the clinical effect of transcatheter arterial chemoembolization ( TACE) combined with radiofrequency ablation ( RFA) in the treatment of Barcelona Clinical Liver Cancer ( BCLC) stage B primary liver cancer and influencing factors for prognosis. Methods A total of 154 patients with BCLC stage B primary liver cancer who were admitted to Beijing YouAn Hospital, Capital Medical University, from January 2007 to January 2012 and underwent TACE combined with RFA were enrolled. Baseline laboratory data and imaging findings were collected for all patients, and all patients were followed up by the outpatient service, hospitalization, or telephone. The Kaplan-Meier method was used to plot survival curves and the log-rank test was used for the analysis of survival curves. The indicators with P < 0. 05 in the univariate analysis were included in multivariate Cox regression analysis. Results The 154 patients with BCLC stage B liver cancer had a median survival time of 37 months and the 1-, 2-, 3-, and 5-year survival rates were 82. 5%, 59. 7%, 50. 6%, and 36. 1%, respectively. The patients were divided into B1, B2, B3, and B4 groups according to the BCLC substage, and the B1 group had a significantly higher survival rate than the B2, B3, and B4 groups ( χ2= 16. 881, P = 0. 001) . The patients with complete ablation at one month after RFA, an age of < 60 years, an alpha-fetoprotein ( AFP) level of < 400 ng/ml, a cholinesterase ( ChE) level of ≥4000 U/L, a total bilirubin ( TBil) level of ≤21 μmol/L, a Child-Pugh class A disease, a number of tumors of ≤3, or a maximum tumor diameter of < 3 cm had a significantly higher survival rate than those with incomplete ablation ( χ2= 173. 002, P < 0. 001) , an age of ≥60 years ( χ2= 6. 336, P = 0. 012) , an AFP level of ≥400 ng/ml ( χ2= 10. 765, P = 0. 001) , a ChE level of < 4000 U/L ( χ2= 6. 933, P =0. 008) , a TBil level of > 21 μmol/L ( χ2= 4. 624, P = 0. 032) , a Child-Pugh class B disease ( χ2= 5. 570, P = 0. 018) , a number of tumors of > 3 ( χ2= 6. 761, P = 0. 009) , or a maximum tumor diameter of > 5 cm ( χ2= 7. 430, P = 0. 024) . The multivariate Cox regression analysis showed that ablation assessment ( odds ratio [OR]= 21. 950, 95% confidence interval [CI]: 11. 817-40. 772, P < 0. 001) , Child-Pugh class ( OR = 2. 190, 95% CI: 1. 329-3. 609, P = 0. 002) , AFP level ( OR = 1. 760, 95% CI: 1. 122-2. 760, P = 0. 014) , and BCLC B substage ( OR = 2. 178, 95% CI: 1. 284-3. 694, P = 0. 004) were influencing factors for survival time after RFA in patients with BCLC stage B liver cancer. Conclusion TACE combined with RFA is safe and effective in the treatment of BCLC stage B liver cancer.Incomplete ablation, a AFP level of ≥400 ng/ml, Child-Pugh class B, and late substage of BCLC stage B are independent risk factors for survival time after RFA in patients with BCLC stage B liver cancer.