Why This Study Matters
Intermediate-stage (Barcelona Clinic Liver Cancer, BCLC stage B) hepatocellular carcinoma (HCC) describes a heterogeneous group of patients with multifocal, liver-confined tumors who are not candidates for curative surgery or transplant but often retain adequate liver function. Transarterial chemoembolization (TACE) has long been the standard of care for this population, but the published abstract describes TACE as having shown "unsatisfactory survival benefits," and outside commentary on the trial places TACE-monotherapy outcomes at a median overall survival on the order of 20 to 35 months across prior studies — a cross-study benchmark rather than a result from this trial itself.
Combining TACE with thermal ablation has already been used at some treatment centers for over a decade, but an accompanying editorial argues that this clinical practice has outpaced the randomized evidence supporting it. The Phase 3 TORCH trial was designed to generate that missing randomized evidence.
Study Design
TORCH was an open-label, Phase 3, randomized clinical trial conducted from May 2015 to August 2024 at two tertiary medical centers in China — Sun Yat-sen University Cancer Center and The Third Affiliated Hospital of Sun Yat-sen University — with a data cutoff of October 31, 2025. Patients with BCLC stage B, liver-confined, unresectable HCC were randomly assigned 1:1 to TACE combined with subsequent selective radiofrequency ablation (TACE-ablation) or to TACE alone. The primary endpoint was progression-free survival (PFS) assessed per RECIST version 1.1; secondary endpoints included overall survival, treatment response and PFS by modified RECIST, untreatable PFS, and safety.
The trial enrolled 241 patients in its intention-to-treat population and is registered as NCT02435953, officially titled "TACE+RFA Versus TACE Alone for Intermediate-stage Hepatocellular Carcinoma (TORCH)."
Patient Population
Baseline characteristics were balanced between the two arms — 121 patients received TACE-ablation and 120 received TACE alone — with similar median age, sex distribution, and tumor burden score across groups.
| Characteristic | TACE-Ablation (n=121) | TACE Alone (n=120) |
|---|---|---|
| Median age | 59.0 years (IQR, 51.0-66.0) | 58.0 years (IQR, 50.0-64.0) |
| Male | 108 (89.3%) | 106 (88.3%) |
| Tumor burden score <6 | 34 (28.1%) | 31 (25.8%) |
| Tumor burden score 6-12 | 79 (65.3%) | 76 (63.3%) |
| Tumor burden score >12 | 8 (6.6%) | 13 (10.8%) |
Primary Endpoint Results
Median PFS per RECIST v1.1 was 17.7 months (95% CI, 11.4-23.1) with TACE-ablation versus 7.3 months (95% CI, 6.4-10.4) with TACE alone (HR, 0.47; 95% CI, 0.34-0.65; P<.001). TACE-ablation also significantly prolonged untreatable PFS: 35.1 months versus 12.3 months (HR, 0.40; 95% CI, 0.27-0.58; P<.001).
Median overall survival was 88.6 months (95% CI, 43.1 months to not estimable) with TACE-ablation compared with 35.1 months (95% CI, 25.4-45.5) with TACE alone (HR, 0.50; 95% CI, 0.34-0.73; P<.001).
Subgroup Analyses
Not specified in source. The published abstract reports only a qualitative statement that clinically meaningful improvements in both PFS and OS were observed in patients with low to moderate tumor burden scores (6 or below, and 6 to 12 points). No exact hazard ratios, confidence intervals, or P values for this or any other subgroup were reported in the abstract or in the external sources reviewed for this article, so none are presented here.
Safety Profile
Grade 3-4 treatment-related adverse events occurred in a similar proportion of patients across arms, slightly more often with the addition of ablation.
| Adverse Events | TACE-Ablation (n=121) | TACE Alone (n=120) |
|---|---|---|
| Grade 3-4 treatment-related AEs | 23 patients (23.2%) | 24 patients (18.3%) |
The abstract does not break these events down by specific adverse event type (for example, post-embolization syndrome, liver abscess, or hepatic failure); that level of detail was not specified in source.
Interpretation and Broader Context
Sequential TACE-ablation could serve as a feasible treatment option for patients with liver-confined unresectable HCC, particularly those with low to moderate tumor burden.
— Lyu et al., JAMA Oncology, 2026 (paraphrased from the published abstract's conclusion)
An accompanying JAMA Oncology editorial argues, in substance, that combination locoregional strategies such as TACE-plus-ablation have generally been adopted into clinical practice faster than the randomized evidence supporting them (this is a paraphrase of the editorial's argument rather than a verbatim quotation, since the full editorial text was not directly accessible for this article). The editorial situates TORCH within a broader divergence in global practice: some Asian treatment centers have used TACE-plus-ablation for over a decade based on institutional experience and guideline support, while many Western centers have instead moved toward transarterial radioembolization with yttrium-90 or TACE combined with immunotherapy. It frames TORCH as filling a long-standing evidence gap for the TACE-plus-ablation approach specifically, rather than as a head-to-head comparison against those alternative Western strategies — no such comparison was tested in this trial.
In this Phase 3 randomized trial of 241 patients with unresectable, intermediate-stage hepatocellular carcinoma, adding sequential radiofrequency ablation to TACE nearly halved the risk of progression (HR, 0.47) and improved overall survival (HR, 0.50) compared with TACE alone, at the cost of a modest increase in grade 3-4 treatment-related adverse events (23.2% vs 18.3%). Because no PMC full-text record was available for this trial as of publication, subgroup-level statistics beyond a qualitative benefit in patients with lower tumor burden are not reported. The results support sequential TACE-ablation as a feasible option for liver-confined, unresectable HCC, particularly outside the Western centers that have already moved toward radioembolization or TACE-immunotherapy combinations.