Background

This study aimed to investigate the efficacy and safety of apatinib plus transarterial chemoembolization (TACE) and radiofrequency ablation (RFA) in the therapy of hepatocellular carcinoma (HCC) patients.

Methods

From December 2015 to June 2018, 175 eligible participants were included in our research. Twenty-four patients who received apatinib plus TACE and RFA were categorized as the TACE + RFA-A group, 82 patients who received apatinib plus TACE were categorized as the TACE-A group, and 69 patients who received TACE alone were categorized as the TACE group. Treatment complications, treatment response, overall survival (OS), and time to progression (TTP) were recorded. Survival analyses were compared. Univariate and multivariate Cox analyses were conducted to investigate the predictive factors for OS and TTP. A subgroup analysis was carried out.

Results

The median TTP was 8.0 months (95% CI 6.7–9.3) in the TACE + RFA-A, which was longer than the TACE-A group (6.0 months, 95% CI 4.8–7.2) and TACE group (3.0 months, 95% CI 2.3–3.7); the difference was statistically significant (P < 0.001). The median OS was 23.0 months (95% CI 12.6–33.4) in the TACE + RFA-A group, 18.0 months (95% CI 16.2–19.8) in the TACE-A group, and 8.0 months (95% CI 5.3–10.7) in the TACE group; the difference was statistically significant (P < 0.001). The objective response rate (ORR) was higher in TACE + RFA-A t group (M1, 70.8% vs 65.9% vs. 46.4%, P = 0.023; M3, 58.3% vs. 53.7% vs. 26.1%, P = 0.001). Multivariate Cox analysis demonstrated that treatment strategy and tumor size were independent prognostic factors for the OS and TTP, whereas the Child–Pugh stage was predictive factor of OS. No treatment-related death was observed. The toxicity was comparable between the two groups.

Conclusion

TACE combined with RFA plus apatinib is a safe three-modality treatment for the intermediate or advanced HCC, and it demonstrated better efficacy than TACE plus apatinib or TACE alone.