Transarterial Chemoembolization Alone Versus Combined With Radiation Therapy as First-Line Therapy for Early-Stage Single Hepatocellular Carcinoma.

Abstract

This study aimed to evaluate survival outcomes of transarterial chemoembolization (TACE) alone versus TACE plus radiation therapy (RT) as first-line treatment in patients with single hepatocellular carcinoma (HCC) within Barcelona Clinic Liver Cancer (BCLC) stage 0-A. We retrospectively analyzed 1243 treatment-naïve patients with BCLC stage 0-A single HCC who received TACE alone (n = 986) or TACE plus RT (n = 257) between January 2008 and December 2018. Propensity score matching and subgroup analyses were performed to compare overall survival (OS) and progression-free survival (PFS) between the treatment groups, and to identify patient subsets most likely to benefit from combined therapy. The median age was 61 years (IQR, 55-69); 38% of the patients had BCLC stage 0 disease, whereas 62% had stage A disease. Baseline characteristics were comparable between groups, except for a higher rate of noncomplete response to TACE in the TACE plus RT group. At a median follow-up of 54.7 months, TACE plus RT demonstrated significantly higher 5-year OS (76.4% vs 62.5%; P < .001) and PFS (41.9% vs 22.3%; P < .001) compared with TACE alone. In the propensity score-matched cohort, TACE plus RT maintained superior 5-year OS (76.4% vs 54.0%; P < .001) and PFS (41.9% vs 12.3%; P < .001). These survival benefits were consistent across subgroups, with significant interactions identified for tumor size (> 4 cm), alpha-fetoprotein levels (> 100 ng/mL), and TACE response (noncomplete response). Incorporating these factors, the TACE-RT stratification model categorized patients into distinct groups with differential treatment effects: groups B (1 factor) and C (2-3 factors) derived significant survival benefits from combined therapy, whereas group A (no factors) showed no differences. Early RT integration yielded superior OS and PFS compared with delayed integration. TACE combined with RT as first-line treatment was associated with improved OS and PFS compared with TACE alone in selected patients with BCLC stage 0-A single HCC. Our TACE-RT stratification model may help identify appropriate candidates for combined therapy.