| Objective As the most common subtype of liver cancer(85% ～ 90%),hepatocellular carcinoma(HCC)is highly malignant;thus,one of the crucial issues in HCC management is an effective therapy for tumors at an early stage,which is vital for improving the prognosis of patients.Thermal ablations(TAs)and Laparoscopic liver resection(LLR)are widely used in clinical minimally invasive treatment techniques.For ≤3cm HCC,TAs have been recommended by international guidelines as a first-line or alternative treatment.However,for larger HCC(3.1 ～ 5.0cm),TAs and LLR are still lacking real-world evidence.Based on this,we organized a real world study involving 12 tertiary hospitals in China.To observe the effect of Microwave ablation(MWA)and LLR on the prognosis of patients with 3.1-5.0 cm HCC with the improvement of technical equipment and experience.In order to provide reliable Evidence-based medicine(EBM)for clinical minimally invasive treatment basis.Methods From January 2008 to October 2019,a multi-center database was composed of 3385 HCC patients admitted to 12 tertiary hospitals in China who were newly diagnosed within 3 and had at least one tumor with a maximum diameter of 3.1-5.0 cm.The first part was a controlled study of MWA and LLR in the treatment of single 3.1-5.0 cm HCC.The second part was a controlled study of MWA and LLR in the treatment of multiple 3.1-5.0 cm HCC.The third part was a controlled study of MWA and LLR in the treatment of 3.1-5.0 cm HCC ≥60years old.Propensity Score matching(PSM)was used to balance the baseline variables between the MWA and LLR groups in all comparison cohorts in a 1:1ratio.Results Part Ⅰ: MWA and LLR had no significant difference in Overall survival(OS)among 1289 single HCC patients((Hazard ratio,HR)0.88,95%(Confidence interval,CI)(0.65-1.19),P=0.420),MWA had a higher risk of recurrence than LLR(HR 1.36,95%CI(1.05-1.75),P=0.017).In the 2014 to 2019 cohort,MWA enabled patients to obtain OS comparable to LLR(HR 0.85,95%CI(0.56-1.30),P=0.460)and disease-free survival(DFS)without statistical difference(HR 1.33,95%CI(0.98-1.82),P =0.071).Part Ⅱ: There was no significant difference in the effect of MWA and LLR on patients ’OS in the cohort from 2008 to 2019(HR 0.85,95%CI(0.51-1.39),P=0.510).MWA was associated with a higher risk of recurrence than LLR(HR2.66,95%CI(1.78-3.99),P<0.001).In the cohort from 2013 to 2019,MWA and LLR resulted in comparable OS(HR 0.77,95%CI(0.39-1.55),P =0.460)and DFS(HR 1.53,95%CI(0.90-2.59),P =0.110).Part Ⅲ: Among 672 patients,there was no significant difference in the influence of MWA and LLR on patients ’OS in the ≥60 years cohort(HR 1.04,95%CI(0.73-1.47),P=0.840).MWA was associated with a higher risk of recurrence than LLR(HR 1.94,95%CI(1.43-2.64),P<0.001).MWA and LLR had no significant effect on OS in patients aged 60 to 64 years(HR 1.28,95%CI(0.80-2.05),P =0.300).The MWA group had a higher risk of recurrence than the LLR group(HR 2.03,95%CI(1.34-3.09),P=0.001).There was no significant difference in the influence of MWA and LLR on OS in 65-69 years old cohort(HR 2.03,95%CI(0.89-4.61),P =0.086).MWA was associated with a higher risk of recurrence(HR 2.28,95%CI(1.15-4.52),P =0.015).MWA and LLR provided comparable OS(HR 0.67,95%CI(0.30-1.49),P=0.320)and DFS(HR 1.37,95%CI(0.68-2.79),P=0.380)for patients aged 70 to 74 years.There was no significant difference in the influence of MWA and LLR on PATIENTS ’OS(HR0.35,95%CI(0.10-1.21),P=0.089)and DFS(HR 1.31,95%CI(0.46-3.79),P=0.610)in ≥75 years old cohort.Conclusion MWA can be used as another first-line treatment for single3.1-5.0 cm HCC after LLR.MWA also showed a certain radical cure potential in patients with multiple HCC and ≥60 years old.MWA was associated with shorter hospital stays,shorter surgery times,and lower overall costs.The above conclusions,if confirmed by prospective studies,may bring hope for a cure for HCC patients who refuse or have difficulty tolerating LLR. |
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