Liver resection versus microwave ablation for hepatocellular carcinoma in ideal candidates for ablation per Barcelona Clinic Liver Cancer staging: a propensity score matching and inverse probability of treatment weighting analysis

Abstract

Summary Background Liver resection (LRE) and microwave ablation (MWA) for hepatocellular carcinoma (HCC) have been widely compared. Aims To compare the therapeutic outcomes of percutaneous MWA and LRE for HCC in ideal candidates for ablation according to Barcelona Clinic Liver Cancer (BCLC) staging Methods Between August 2013 and November 2020, 483 consecutive patients meeting criteria for “ideal candidates for ablation” per the BCLC staging initially treated with MWA (n = 168) or LRE (n = 315) were included. Patients were further divided into BCLC‐0 (n = 116) and BCLC‐A (n = 367) groups. Overall survival (OS), recurrence‐free survival (RFS) and post‐procedure‐related complication rates were compared before and after propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) in the overall population and subgroups. Multivariate Cox regression analysis was performed to determine whether the treatment modality was an independent prognostic factor. Results LRE had a better RFS and similar OS and post‐procedure‐related complication rates compared to MWA in the overall population and in the BCLC‐A subgroup both before and after PSM and IPTW. However, the OS, RFS and post‐procedure‐related complication rates were equivalent between the two groups before and after PSM and IPTW in patients with BCLC‐0 disease. The multivariate Cox regression analysis showed that LRE was associated with better RFS over MWA in overall population (p = 0.003; HR = 0.67; 95% CI: 0.51–0.87) and BCLC‐A disease (p = 0.046; HR = 0.74; 95% CI: 0.56–0.99), while it did not differ in OS. Conclusion An ‘ideal candidate for ablation’ according to the BCLC staging system may not be an ideal candidate for MWA. However, patients with BCLC‐0 may be the optimal population for MWA.

Editorial: is microwave ablation an alternative to liver resection for hepatocellular carcinoma? Authorsʼ reply

“…He et al summarised their 2019 study by comparing microwave ablation to resection in patients with hepatocellular carcinoma (HCC) within Milan criteria; their results differed in some respects from ours 1–3 . In contrast to our study, they showed a higher tumour recurrence rate for the microwave ablation (MWA) group even in patients with small HCC (<3 cm).…”

Editorial: is microwave ablation an alternative to liver resection for hepatocellular carcinoma?

“…Tong et al demonstrated that liver resection had a better recurrence‐free survival (RFS) and similar overall survival (OS) compared to percutaneous microwave ablation (MWA) in the “ideal candidate for ablation” population according to the Barcelona clinic liver cancer (BCLC) staging system and in the BCLC‐A subgroup, whereas the OS and RFS were similar in patients with BCLC‐0 disease 1 …”

Letter: repeat hepatic resection versus radiofrequency ablation for recurrent hepatocellular carcinoma in ideal candidates

“…We would like to congratulate Tong et al on their interesting study which revealed the 'ideal candidates' with hepatocellular carcinoma (HCC) for microwave ablation (MWA). 1 They found that hepatectomy resulted in a better recurrence-free survival (RFS) and similar overall survival (OS) compared to MWA. Other studies also found that hepatectomy and MWA provide similar OS for HCC within the Milan criteria.…”