Background and Aims: Transcatheter arterial chemoembolization (TACE) is an important treatment modality for intermediate and advanced hepatocellular carcinoma (HCC). For further improving the therapeutic efficacy of intermediate and advanced HCC, the combined treatment of TACE and radiofrequency ablation (RFA) has also been applied in clinical practice. However, there is still no high quality randomized controlled studies to verify the efficacy of the combined treatment. Therefore, this study was designed to investigate the clinical efficacy of TACE combined with RFA in treatment of intermediate and advanced HCC after reducing the confounding bias by propensity score matching (PSM). 
Methods: The clinical data of patients with intermediate or advanced HCC undergoing TACE alone (TACE) or TACE combined with RFA (combined group) and meeting the inclusion criteria from January 2012 to January 2018 in the Department of Hepatobiliary Surgery of the Affiliated Hospital of Southwest Medical University were collected. After the clinical data of the two groups of patients matched 1:1 using PSM, the differences in overall survival rates and the survival rates among stratified subgrouping with different clinical factors between the two groups of patients were compared by Kaplan-Meier method. 
Results: A total of 211 eligible patients were enrolled, with 127 case in TACE group and 94 cases in combined group, and then 160 patients were successfully matched after PSM. The median survival time of patients in TACE group and combined group were 18 and 22 months, respectively, and the 1, 2 and 3-year survival rates were 91.3% 57.9, and 16.1%, and 94.4%, 66.2% and 29.2%, respectively. The survival rate of patients in combined group was significantly superior to that of patients in TACE group (P=0.024). The results of further subgroup analysis showed that the survival rate in combined group was significantly superior to that in TACE group among patients with AFP≤400 ng/mL or patients with solitary lesion (P=0.044, P=0.037), while the survival rate had no significant difference between TACE group and combined group among patients with AFP>400 ng/mL, or patients multiple lesions as well as with Child A or B disease (all P>0.05).
Conclusion: Compared with TACE alone, the combined treatment of TACE and RFA has obvious advantage in improving the survival time of patients with intermediate or advanced HCC. TACE combined with RFA can significantly prolong the survival time of patients with AFP≤400 ng/mL and single tumor, but has no evident superiority for those with multiple tumors and AFP>400 ng/mL. Moreover, the Child classification may not be the reference index for the selection of TACE plus RFA treatment.