| ObjectiveThis study is to compare the efficacy and safety of transcatheter arterial chemoembolization(TACE)combined with microwave ablation(MWA)versus single TACE in the treatment of large hepatocellular carcinoma(defined as tumor diameter larger than 5cm),and to investigate the efficacy and combined benefits of TACE combined with MWA in the treatment of large hepatocellular carcinoma.MethodsA retrospective was used to collect a total of 100 patients with large hepatocellular carcinoma who were hospitalized during 2018.1-2022.12 in Jingzhou Central Hospital.The patients were grouped according to their different surgical procedures:group A(patients treated with TACE combined with MWA)and group B(patients treated with single TACE).The recent efficacy and tumor control after 3 months of treatment were compared between the two groups using the modified response evaluation criteria in solid tumors(m RECIST),the quality of life of patients 30 days after discharge from hospital was compared using the GQOLI-74 questionnaire,Kaplan-Meier and Log-rank were used to analyze patients’survival outcomes and overall survival time.Laboratory indicators and imaging data before and after surgery were recorded in the two groups,complications after treatment were compared between the two groups,and COX regression was used to analyze the factors affecting the survival of patients with large hepatocellular carcinoma.Results1.The 93 patients with large hepatocellular carcinoma were included,including 47patients in group A and 46 patients in group B.The clinical baseline information of the two groups was comparable,with a median follow-up time of 21 months.Short-term efficacy after 3 months of treatment was assessed using m RECIST,cases with complete response,partial response,stable disease,and progressive disease in group A were22,17,7,and 1,and those in the group B were 5,22,16,and 3.The objective remission rate after 3 months of treatment was better in group A than in group B(82.9%VS 58.7%,χ~2=6.653,P=0.010);there was no statistically difference in the disease control rate between the two groups(97.9%VS 93.5%,χ~2=0.284,P=0.594).2.The median progression-free survival time and overall survival time for patients in group A were 15 months(95%CI 7.8～22.3)and 40 months(95%CI 34.2～47.9),compared to 11 months(95%CI 7.7～13.3)and 26 months(95%CI 20.3～31.7)in group B.The 1-,2-and 3-year progression-free survival rates in group A were 72.5%,41.2%and26.5%,and those in group B were 38.2%,13.7%and 5.1%.The 1-,2-and 3-year overall survival rates in group A were 81.4%,74.7%and 68.4%,and those in group B were 63.3%,50.9%and 42.7%.Patients in group A had a greater advantage in progression-free survival time and overall survival time(Log-rank:χ~2=8.170,P=0.004;χ~2=7.445,P=0.006).3.The results of the COX regression univariate analysis:whether MWA was combined with TACE,the patient’s gender,the patient’s Child-Pugh liver function classification,the BCLC stage of the tumor,and the number of tumors were the factors associated with the overall survival time of patients with large HCC.The results of the COX regression multifactorial analysis:the addition of MWA after TACE reduced the risk of death(HR=0.383,95%CI 0.197～0.745,P=0.005);the risk of death was approximately 59.9%lower in female patients than in male patients(HR=0.401,95%CI0.203～0.790,P=0.008).Patients with Child-Pugh B had 2.66 times higher risk of death than Child-Pugh A(HR=2.665,95%CI 1.252～5.672,P=0.011);BCLC stage C had 1.62times higher risk of death than BCLC stage B(HR=2.621,95%CI 1.310～5.244,P=0.006).4.Patients in group A had a higher mean quality of life after 30 days of discharge(group A VS group B42.49 VS 36.95),and the difference was statistically significant(t=-4.673,P<0.001).Patients in group A had less impairment of liver function(44.7%VS58.7%)and lower AFP values(56ng/ml VS 217ng/ml,P=0.04).5.The difference in the incidence of complications during treatment between the two groups was not statistically significant(P>0.05).The adverse events that occurred were all grade 1-2,and the main complications were liver function,pain in the liver area,and fever;and the few complications were gastrointestinal bleeding,hepatic subcapsular hematoma,and liver abscess.All complications could be relieved after symptomatic treatment.ConclusionPatients in group A(TACE combined with MWA treatment)can significantly prolonged the survival time,and reduce tumor recurrence rate and liver function injury compared with patients in group B(single TACE treatment);the overall efficacy of group A was significantly better than group B.The method of TACE combined with MWA treatment for large hepatocellular carcinoma was feasible,effective and safe. |
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