Unresectable Hepatocellular Carcinoma: Transcatheter Arterial Chemoembolization Combined With Microwave Ablation vs. Combined With Cryoablation

Abstract

Background: Transcatheter arterial chemoembolization (TACE) combined with ablation has been widely used for treating unresectable hepatocellular carcinoma (HCC). However, the technique with which TACE should be combined for it to be more effective remains unknown. Purpose: To retrospectively evaluate the efficacy and safety of TACE combined with microwave ablation (MWA) vs. TACE combined with cryoablation (CRA) in treating unresectable HCC. Materials and Methods: From January 2011 to December 2018, 108 patients diagnosed with unresectable HCC were divided into either the TACE-MWA group (n = 48) or TACE-CRA group (n = 60). Overall survival (OS) and time to progression (TTP) were compared between the two groups. To reduce potential bias, a propensity score matching (PSM) was performed. Complications were observed. Kaplan-Meier survival curves were constructed and compared using the log-rank test. Results : The baseline characteristics of the two groups were balanced. The median OS was 20.9 months (95% CI 14.3-27.6 months) in the TACE-MWA group and 13.0 months (95% CI 8.8-17.1 months) in the TACE-CRA group (P = 0.096). The median TTP was 8.8 months (95% CI 4.3-13.4 months) in the TACE-MWA group and 9.3 months (95% CI 7.1-11.5 months) in the TACE-CRA group (P = 0.675). After PSM, 48 patients remained in each group. The median OS in the TACE-MWA and TACE-CRA groups was 20.9 months (95% CI 14.3-27.6 months), and 13.5 months (95% CI 8.4-18.6 months, P = 0.100), respectively. The median TTP in the TACE-MWA and TACE-CRA groups was 8.8 months (95% CI 4.3-13.4 months), and 8.6 months (95% CI 3.1-14.2 months, P = 0.909), respectively. The overall incidence rate of ablation-related complications was lower in the TACE-MWA group than in the TACE-CRA group (66.7 vs. 88.3%, P = 0.006). Multivariate analysis showed that the presence of portal vein tumor thrombus (PVTT) and the maximum diameter of intrahepatic tumor were significant prognostic factors for OS and TTP. Conclusion: The efficacy of TACE-MWA and TACE-CRA in the treatment of unresectable HCC was comparable. TACE-MWA was more promising because of a lower complication rate, especially with regard to thrombocytopenia. Further prospective randomized controlled trials are required to validate our findings.

Comparison of Efficacy and Safety of TACE Combined with Microwave Ablation and TACE Combined with Cryoablation in the Treatment of Large Hepatocellular Carcinoma

“…is study found that TESE-MWA and TESE-CRA had similar efficacy in the treatment of advanced unresectable liver cancer, but the complication rate of TESE-MWA was lower [19]. is study further explored the therapeutic effects of different therapeutic regimens for hepatocellular carcinoma in terms of tumor size and tumor type.…”

“…Wei et al selected 108 patients with advanced liver cancer and divided them into the TACE-MWA group ( n = 48) and THE ACE-CRA group ( n = 60), compared the overall survival (OS) and time to disease progression (TTP) of the two groups, and observed the occurrence of complications in the two groups. This study found that TESE-MWA and TESE-CRA had similar efficacy in the treatment of advanced unresectable liver cancer, but the complication rate of TESE-MWA was lower [ 19 ]. This study further explored the therapeutic effects of different therapeutic regimens for hepatocellular carcinoma in terms of tumor size and tumor type.…”

Combined treatments in hepatocellular carcinoma: Time to put them in the guidelines?

“…The analysis included over 1700 patients, all from Chinese-conducted studies, and showed a significantly higher OS for the latter (1-year OS rate: RR = 1.36, 95%CI: 1.28–1.44; 2-year OS rate: RR = 1.56, 95%CI: 1.40–1.74, and 3-year OS rate: RR = 2.07, 95%CI: 1.67–2.57, P < 0.001). However, when compared to other non-standard therapies, such as radiation segmentectomy[ 55 ] or CA[ 63 ] the differences in outcome were not statistically significant, which might further suggest the rather suboptimal standard of care for intermediate HCC. Other clinical scenarios have shown a benefit of combination therapy, as TACE + MWA + Sorafenib outperformed TACE + Sorafenib in off-guideline advanced HCC[ 58 ].…”

Drug-eluting bead trans-arterial chemoembolization combined with microwave ablation therapy vs. microwave ablation alone for early stage hepatocellular carcinoma: a preliminary investigation of clinical value

“…A retrospective study conducted by Zheng L showed better OS rates in the TACE + MWA group compared with the TACE alone group in patients with large HCC, with 1-, 2-, and 3-year OS rates of 85.9%, 59.8%, and 32.6% vs. 59.0%, 40.4%, and 11.4%, respectively (Zheng et al 2018). Wei J and colleagues confirmed that TACE + MWA had superiority in prolonging median OS and reducing TTP compared with TACE + cryoablation (CRA) in treating unresectable HCC (Wei et al 2020). In addition, our results showed that the OS rates at 1, 3, and 5 years in DCB-TACE + MWA group were 100%, 89.4% and 65.7%, respectively, which were similar with those reported by Li Z; the OS rates at 1, 3 and 5 years were 98.0%, 89.8%, and 74.3%, respectively, in patients with small HCCs treated with TACE + MWA (Li et al 2020).…”