Surgical resection versus thermal ablation: comparison of sequential options after successful TACE downstaging therapy for unresectable hepatocellular carcinoma

Chao An; Songsong Wu; Mengxuan Zuo; Wang Li; Kai Li; Peihong Wu

doi:10.1177/17588359241306648

Surgical resection versus thermal ablation: comparison of sequential options after successful TACE downstaging therapy for unresectable hepatocellular carcinoma

Ther Adv Med Oncol. 2025 Jan 1:17:17588359241306648. doi: 10.1177/17588359241306648. eCollection 2025.

Authors

Chao An¹, Songsong Wu², Mengxuan Zuo¹, Wang Li¹, Kai Li³, Peihong Wu⁴

Affiliations

¹ State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Minimal Invasive Intervention, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China.
² Shengli Clinical Medical College of Fujian Medical University, Fuzhou, P.R. China.
³ Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province 510630, P.R. China.
⁴ State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Minimal Invasive Intervention, Sun Yat-sen University Cancer Center, 651, Dongfeng East Road, Guangzhou 510060, P.R. China.

Abstract

Background: Transarterial chemoembolization (TACE) is an effective and safe downstaging therapy for hepatocellular carcinoma (HCC). However, the selection of sequential therapeutic modalities is still controversial.

Objectives: This study compared the effectiveness and safety of surgical resection (SR) and thermal ablation (TA) after patients with HCC underwent TACE downstaging therapy.

Design: A retrospective, multi-institutional study.

Methods: From June 2008 to October 2022, a total of 4782 consecutive patients with HCC beyond the initial Milan criteria underwent TACE at 12 hospitals. Among them, 609 patients who received successful downstaging therapy were retrospectively reviewed. Among them, 209 patients underwent an SR, and 390 patients received TA after TACE. The propensity score matching (PSM) method was applied to reduce selection bias between groups. Cumulative overall survival (OS) and progression-free survival (PFS) were compared using the Kaplan-Meier method with the log-rank test.

Results: After PSM 1:1 (n = 185 in both groups), the cumulative 1-, 3-, 5-, and 10-year OS rates were 98.8%, 89.3%, 82.9%, and 64.4%, respectively, in the SR group and 99.5%, 88.4%, 75.3%, and 53.9%, respectively, in the TA group; these two groups were not significantly different (HR: 1.22; 95% CI: 0.78-1.89; p = 0.381). The cumulative 1-, 3-, 5-, and 10-year PFS rates were 88.5%, 69.2%, 58.8%, and 32.2%, respectively, in the SR group and 90.6%, 71.4%, 53.1%, and 32.0%, respectively, in the TA group, revealing no significant difference between the two groups (HR: 0.97; 95% CI: 0.71-1.32; p = 0.855).

Conclusion: For HCC patients beyond the Milan criteria who received TACE downstaging therapy, TA might be acceptable as an alternative to SR in the first-line sequential treatment scheme.

Keywords: downstaging therapy; hepatocellular carcinoma; surgical resection; thermal ablation; transarterial chemoembolization.

Plain language summary

An exploratory study of TACE conversion therapy This retrospective, multi-institutional study revealed that thermal ablation (TA) and surgical resection (SR) had comparable long-term survival and safety profiles after transarterial chemoembolization (TACE) downstaging therapy in patients with hepatocellular carcinoma (HCC) beyond the initial Milan criteria. TA is an acceptable first-line alternative to SR for selected patients with higher stages of HCC who receive TACE downstaging therapy, especially those unsuitable for SR.