Sequential transarterial chemoembolization and percutaneous acetic acid injection therapy versus repeated percutaneous acetic acid injection for unresectable hepatocellular carcinoma: a prospective study

Background: Transarterial chemoembolization (TACE) and percutaneous acetic acid injection (PAI) are effective treatments for hepatocellular carcinoma (HCC). We have conducted a prospective study to compare the efficacy of sequential TACE and PAI (TACE-PAI) versus repeated PAI therapy for HCC. Patients and methods: A total of 108 HCC patients with tumor size less than or equal to 5 cm were enrolled. Fifty-three patients were treated with TACE-PAI and 55 patients were treated with PAI alone. Results: Objective responses were achieved in 72 of 80 nodules (90%) in the TACE-PAI group compared with 51 of 62 nodules (82%) in the PAI group (P = 0.217) during 24 +/- 10 months of follow-up. Patients in the TACE-PAI group had a significantly lower cumulative tumor recurrence rate from the treated nodule (P = 0.004) or newly developed tumor elsewhere in liver (P = 0.010). Complete tumor necrosis in large (3-5 cm) HCCs was more frequently encountered in the TACE-PAI group (64% versus 37%; P = 0.034). There was no significant survival difference between the two groups with small (less than or equal to 3 cm) HCC (P = 0.569), whereas PAI therapy was an independent poor prognostic predictor [relative risk 3.0 (95% confidence interval 1.2-7.6); P = 0.017] in the large HCC group. Conclusions: Sequential therapy with TACE and PAI is superior to repeated PAI alone for patients with large HCC.