Comparison of the Efficacy and Prognostic Factors of Transarterial Chemoembolization Plus Microwave Ablation versus Transarterial Chemoembolization Alone in Patients with a Large Solitary or Multinodular Hepatocellular Carcinomas

Abstract

ObjectiveTo evaluate the efficacy and prognostic factors associated with transcatheter arterial chemoembolization (TACE) combined with microwave ablation (MWA) versus TACE alone for a large solitary or multinodular hepatocellular carcinomas (HCCs).Materials and MethodsThis retrospective study involved 258 patients with a large solitary or multinodular HCCs (not more than 10 tumors) who underwent TACE + MWA (n = 92) or TACE alone (n = 166) between July 2011 and April 2015. Local tumor control, survival outcomes, and complications were compared between the two groups. Prognostic factors for time to progression (TTP) and overall survival (OS) were evaluated by univariate and multivariate analyses.ResultsThe median duration of follow-up was 21.2 months (range, 4–45 months). The median TTP and OS were 12.5 months and 26.6 months, respectively, for the TACE + MWA group and 6.7 months and 17.1 months, respectively, for the TACE group (p < 0.001). The 1-, 2-, and 3-year OS rates were 85.9, 59.8, and 32.6%, respectively, for the TACE + MWA group and 59.0, 40.4, and 11.4%, respectively, for the TACE group (p < 0.001). The corresponding recurrence rates were 47.8, 78.3, and 94.6% for the TACE + MWA group, respectively, and 74.7, 96.4, and 97.6%, respectively, for the TACE group (p < 0.001). Logistic regression analyses showed that the treatment method, tumor size, and tumor number were significant prognostic factors for TTP and OS.ConclusionTACE + MWA appears to have more advantages compared to TACE in prolonging OS, with a satisfactory TTP, for inpatients with solitary large or multinodular HCCs. Treatment method, tumor size, and tumor number are significant prognostic factors for TTP and OS. Further randomized, multi-center, prospective trials are required to confirm the findings of this study.

Clinical conditions and treatment requirements for long‐term survival among hepatitis B‐related hepatocellular carcinoma initially treated with chemoembolization

“…Consistent with previously studies, our analysis demonstrates that an add‐on resection or ablation after initial TACE significantly extended the survival time and increased the percentage of patients who reached a 3‐year survival time . This suggests that add‐on resection/ablation works synergistically with TACE.…”

“…In addition, the add-on resection or ablation removes or necrotizes hypovascular HCC lesions that are refractory to cytotoxicity by TACE delivered chemicals. 57,58 In further analysis, vascular invasion was the only risk factor that compromised the long-term survival in patients who received the add-on resection and/or ablation after TACE. This finding reveals that the efficacy of the add-on resection and/ or ablation is effective in eliminating almost all of the factors that are required to achieve the 3-year survival in the group without resection and/or ablation after TACE.…”

“…TACE reduces or stabilizes the size of large HCCs and induces ischemia and inflammatory edema in tumor tissues, which provide favorable conditions for the success of add‐on resection or ablation treatment. In addition, the add‐on resection or ablation removes or necrotizes hypovascular HCC lesions that are refractory to cytotoxicity by TACE delivered chemicals …”

“…Consistent with previously studies, our analysis demonstrates that an add-on resection or ablation after initial TACE significantly extended the survival time and increased the percentage of patients who reached a 3-year survival time. [56][57][58][59] This suggests that add-on resection/ ablation works synergistically with TACE. TACE reduces or stabilizes the size of large HCCs and induces ischemia and inflammatory edema in tumor tissues, which provide favorable conditions for the success of add-on resection or ablation treatment.…”

Comparison of albumin-bilirubin grade, platelet-albumin-bilirubin grade and Child-Turcotte-Pugh class for prediction of survival in patients with large hepatocellular carcinoma after transarterial chemoembolization combined with microwave ablation

“…However, a limited number of studies reported the long-term outcomes of TACE-MWA for large HCCs. Zheng et al reported mediumterm outcomes of TACE-MWA in 92 patients with large HCCs, with a 3-year OS rate of 32.6% [35]. In that study, 44 (47.8%) patients exhibited HCC lesions with a maximum diameter >10 cm, and tumor size was confirmed as a significant predictor of OS.…”