Single medium-sized hepatocellular carcinoma treated with sequential conventional transarterial chemoembolization (cTACE) and microwave ablation at 4 weeks versus cTACE alone: a propensity score

Abstract

Background Microwave ablation (MWA) is a potentially curative treatment for unresectable patients with hepatocellular carcinoma (HCC) ≤ 3 cm, while its therapeutic efficacy decreases significantly for HCC > 3cm. Previous studies have demonstrated that conventional transarterial chemoembolization (cTACE) combined with MWA (cTACE-MWA) may improve local tumor control rate and reduce the recurrence rate for HCC > 3cm. However, there have been few study designs to analyze the clinical efficacy of cTACE-MWA for medium-sized HCC (3–5cm). Therefore, this study aims to compare the clinical efficacy and safety of cTACE-MWA with cTACE alone for a single medium-sized HCC of 3–5 cm in diameter. Methods We retrospectively investigate the data of 90 patients with a single medium-sized HCC who were referred to our hospital and underwent cTACE-MWA or cTACE alone from December 2017 to March 2020. Then, patients were identified with propensity score-matched (1:1). The local tumor response to treatment and time to progression (TTP) were compared using mRECIST criteria between the cTACE-MWA group and the cTACE group. Results A total of 42 patients were included after matching (cTACE-MWA: 21; cTACE: 21). Comparing with cTACE, cTACE-MWA demonstrate significantly better local tumor control (ORR: 95.2% vs 61.9%, p = 0.02; DCR: 95.2% vs 66.7%, p = 0.045) and TTP (median 19.8 months vs 6.8 months, p < 0.001). The 1- and 2-year cumulative probabilities of OS were 100% and 95% in the cTACE-MWA group, which were significantly higher than those in the cTACE group (95% and 76%) (p = 0.032). Multivariate Cox regression analysis illustrates that cTACE-MWA was associated with better TTP (hazard ratio, 0.28; 95% CI: 0.1, 0.76; p = 0.012), but tumor size was associated with worse TTP (hazard ratio, 1.71; 95% CI: 1.01, 2.89; p = 0.045). Conclusions cTACE followed by MWA improved TTP and OS in patients with a single medium-sized HCC, and no major complication was observed in this study.

Short-term efficacy of microwave ablation in the treatment of liver cancer and its effect on immune function

“…The application of medical image-guided percutaneous microwave ablation has gradually entered clinical practice. Microwaves cause tumor cells to rub against each other and generate heat, leading to tumor cell necrosis and apoptosis under high-temperature conditions[ 12 , 13 ]. Ryu et al [ 14 ] detected no significant differences in overall survival and recurrence-free survival between liver resection and microwave ablation treatments in patients with single hepatocellular carcinoma of ≤ 5 cm.…”

Liver abscess formation after transarterial chemoembolization in patients with malignant hepatic tumors: a systematic review and meta-analysis

“…The pooled mortality rate of liver abscess formation after TACE was 7.73%, and the main causes of death included septic shock and acute liver failure [5,39,42]. The mortality rate reached > 50% in the 1990s but dropped signi cantly to 9.65% between 2001 and 2010 and to 5.48% in the past decade.…”

“…The pooled mortality rate of liver abscess was 7.73% (95% CI, 1.72-13.74%) in 10 studies [4,5,23,25,26,29,32,38,39,42] (Fig. 4a).…”

Effectiveness and safety of sequential transarterial chemoembolization and microwave ablation for subphrenic hepatocellular carcinoma: A comprehensive evaluation

“…TACE was performed 4-6 weeks before MWA, as reported in our previous study[ 22 ]. Briefly, a 5F RH catheter (Terumo, Tokyo, Japan) was introduced over a 0.035-inch hydrophilic guidewire (Terumo) to catheterize the celiac, superior mesenteric artery, and any suspected artery feeding the tumor.…”