| Objective:(1) Using prospective cohort study to compare the short-term therapeutic effectiveness of cooled-probe microwave ablation (MWA) vs transcatheter arterial chemoembolization (TACE) on early-stage hepatocellular carcinoma (HCC) to provide clinical foundation for the choice of different liver cancer treatment methods.(2) To investigate the major complications of percutaneous cooled-tip microwave ablation (MWA) for the treatment of primary liver cancers and the possible risk factors in a large series of patients.Materials and Methods:(1) From October2010to December2011, according to following enrollment standard,48patients (58nodules) were treated by percutaneously MWA,53patients (70nodules) were treated by TACE. They were designated as MWA group and TACE group, respectively. All patients were proved by pathology test or two contrast-enhanced imaging modalities. The patients with tumor size of single tumor less than5cm in diameter, with less than3tumors in number and less than3cm in the largest diameter, with the liver function Child-Pugh class A or B classification and no evidence of vein or bile duct tumor embolus, extrahepatic metastasis, no other anti-cancer treatment receiving were enrolled in the study and follow-up period more than three months. Written informed consents for participation in the study were obtained from all the patients. We compared prospectively the post-ablation hospitalization, hospital expense, the technical success rate, Complete Response (CR), Partial Response (PR), Progressive Disease (PD), Local Tumor Progression (LTP), distant recurrence, complications, short-term overall survival and recurrence-free survival between two groups.(2) This study was a retrospective study, which used a percutaneous cooled-tip MWA technique and a standardized protocol for follow-up. Over a5-year follow-up,693patients at our hospital underwent ultrasonographically guided percutaneous cooled-tip MWA. Mortality and treatment-related major complications were documented. Data was subsequently analyzed to determine whether the major complication rate was related to sex, age, diameter of tumors, number of MWA sessions, location of tumors, type of tumors, liver cirrhosis, Child-Pugh classification, preablation serum AFP level, number of antennae, frequency, power, time of MWA, and time of MWA.Results:(1) MWA were performed in58tumors with a successful rate of100%(58/58). When MWA were performed for3months, CR, PR rates were100%(48/48),0%(0/48), respectively. PD rate was18.8%(9/48). Local tumor progression (LTP), intrahepatic metastasis and extrahepatic metastasis rates were1.7%(1/58),16.7%(8/48),4.2%(2/48), respectively. The major complication rate was2.6%(2/78). The median follow-up time was9.3months. The12-and17-month cumulative survival rates were97.9%(47/48),97.9%(47/48), respectively. The 12-mo nt h r e c ur r e nc e-f re e su rv iv a l ra te w a s88.9%. TA C E w e r e p e r f o r me d in70tu mo rs w it h as uc c e s s f u l ra te o f100%(70/70). W h e n TA CE were p e r f o r m e d f o r3mo nt hs, C R, PR ra te s w e re75.5%(40/53),9.4%(5/53), re spe c t iv e ly. PD ra te was35.9%(19/53). L o c a l tu mo r pr o g re s s io n(L T P), i nt ra he p a t ic me t a st a si s a nd e xt ra hep at ic met a s t a s i s r a te s w e r e15.7%(11/70),35.9%(19/53),3.8%(2/53), re s p e c t ive ly. Th e majo r com pl ic a t i o n r a te w a s4.9%(3/61). T he me di a nf o llo w-u p ti me w a s11.4mo nt hs. Th e12-and17-m o nt h c u m ul a t ive s u r v iva l r a te s w e re96.2%(51/53),96.2%(51/53), re spe c t ive ly. Th e12-m o nt h r e c u r r e nc e-f r e e s u r vi va l ra te w a s71.1%. T he r a te of C R, PR, PD, LT P, d ist a nt re c ur r e nce, maj o r c om p lic a t io ns be t w e e n tw o g ro up s a re s ig n if ic a n t d iffe re n t s ta t is t ic a lly (P <0.05). Th e ra te of s ho r t-t e r m o ve r a ll s ur vi v a l a nd re c u rr e nc e-f r e e s u r viv a l a re no t s ig ni fic a nt d iffe re n t st ati st ically (P>0.05).(2) I n to ta l,693pa ti e n t s w it h898p r ima r y live r tu mo rs w e re tr e a te d. A to t a l o f1111MW A s e s s i o n s (a ve r a g e1.2±0.4s e s s io n s p e rtu m o r) w e re p e rf o rm e d. Th e me a n d ia met er of tu m o r s w a s2.5c e nt ime t e r±1.2(s ta nda rd d e v ia t io n) a n d th e ra nge w a s0.4-10.0c e nt imet er. Th r e e de a t hs w e r e e n c o u nt e re d in th e p e ri-a bl a t io n pe ri o d, in c lu d in g o ne c a se d yin g o f mu lt io rg a n f a i l u r e, o ne c a s e dy in g of p u lmo na ry e mb o lis m a n d o ne c a s e d yin g o f he pa t or en al syn d ro me. M a jo r c o mp lic a t io ns oc c u rr e d in27(2.43%) pa ti e nt s a n d inc lud e d12p le u ra l effu sio n re q ui r i n g th o r a c e nt e s is (1.08%),10tu m o rs e e d in g (0.90%),3live r a bsc e ss a nd e mp yem a (0.27%),1he mo r r h a ge r e q ui ri ng a rt e ri a le mbo liz a t io n (0.09%),1bile du c t inj u ry (0.09%). Acco r d i n g t o C hi s-s qu a r e te s t re s u lt, di a me t e ro f tu m o r s, nu mb e r o f MW A se ssi o n s a n d ty pe o f t um o r w e r e a s s o c ia t e d w it h th e ma jo rc o mp lic a t io ns ra te (P <0.05). Th e mul t ip le vari ab les1o g i s t i c r e gr e s s io n a n a ly s is s h o w e d th a to nly ty p e o f tu mo rs w a s a sso c ia t e d w it h th e majo r c o m p l i c a t io ns r a te (P <0.05). T he pa t ie n t sw it h c ho la n gi o c a rc ino ma (I C C) mo re lik e ly oc cu r maj o r c o m p l ic a t io ns.C o nc lus io n:(1) Pe rc u ta ne o u s c o ol e d-p ro be MWA un d e r u l t r a s ou nd g u ida n c e fo r e a rl y H C Cha s hig h e r tu mo r re s po nse ra te, be t te r tu m o r lo cal and d i s t a nt c o nt r o l a b ilit y, a nd le s s ma jo rc o mp lic a t io ns th a n TA C E.(2) Re su lt s o f th is st u d y c o nf i r m th a t p e r c ut a ne o u s c o ol e d-p r o beM W A w a s a re la t iv e ly lo w-r i sk a n d e ffe c t iv e mini m a l l y i n v a s ive pr o c e du r e f o r th e tr e a tm e nt o fp r ima r y live r c a nc e r. Pr o pe r di re c t io n fo r th e tr e atm en t o f I C C p a t ie n t s a s w e ll a s fe w e r a bl a t e dtu m o r nu mbe rs d ur i n g on e ho sp it a liz a t io n co u ld hel p m i n i m i z e ma jo r c o mpl ic a t io ns ra te. |
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