Background and Aims: For recurrent hepatocellular carcinoma (HCC), liver transplantation and repeat hepatectomy are the major treatment methods, but they all have their limitations and are not applicable to all patients. Moreover, transarterial chemoembolization (TACE) and percutaneous microwave ablation (PMCT) are also effective methods for recurrent HCC. However, whether the combined treatment of TACE and PMCT can further improve the treatment efficacy has not been reported. Therefore, this study was aimed to compare the clinical efficacy of TACE plus PMCT and TACE alone in treatment of recurrent HCC.  
Methods: According to the inclusion criteria, the clinical data of 530 patients treated in the Department of Hepatobiliary Surgery of the Affiliated Hospital of Southwest Medical University from January 2007 to January 2019 were collected. Of the patients, 161 cases underwent TACE plus PMCT treatment (observation group), and 369 cases underwent PMCT alone (control group). Patients in both groups underwent repeated performance of the procedures until complete tumor ablation shown by CT examination. The overall survival rate (OS) and relapse-free survival (RFS) of the two groups after treatment were compared, and the prognostic factors were also analyzed. 
Results: There were differences in some baseline data between the two groups of patients, so the two groups of patients were 1:1 matched by propensity score matching (PSM) method, and then resulted in 150 pairs of patients with balanced baseline data from the two groups. In the 300 patients, the median follow-up time was 24.5 months. the median OS and RFS in observation group were significantly longer than those in control group (43.1 months vs. 19.0 months, P=0.001; 36.0 months vs. 16.7 months, P=0.002). The 1- and 2-year OS and RFS between the two groups showed no significant differences (all P>0.05), but the 3-, 4- and 5-year OS and RFS in observation group were significantly superior to those in control group (all P<0.05). Cox multivariate regression analysis showed that TACE plus PMCT treatment (HR=1.473, 95% CI=1.094–1.983, P=0.011) and liver cirrhosis (HR=1.101, 95% CI=1.041–1.165, P=0.001) were independent factors affecting the OS of patients with recurrent HCC; TACE plus PMCT treatment (HR=1.093, 95% CI=1.037–1.151, P=0.001) and degree of differentiation (HR=1.445, 95% CI= 1.135–1.840, P=0.003) were independent factors affecting the RFS of patients with recurrent HCC.
Conclusion: TACE combined with PMCT is a safe and effective method for recurrent HCC, its clinical efficacy in superior to that of TACE alone, and it can significantly improve the prognosis of patients with recurrent HCC.