Analysis Of Efficacy And Prognostic Factors Of Laparoscopic Ultrasound-guided Microwave Ablation In The Treatment Of Hepatocellular Carcinoma

ObjectiveTo explore the clinical value of laparoscopic ultrasound-guided microwave ablation(LUS-MWA)in the treatment of hepatocellular carcinoma(HCC)and analyze its related prognostic factors to provide a basis for further individualized treatment of patients.MethodsA total of 100 patients with primary liver cancer who underwent laparoscopic surgery in the Department of Hepatobiliary Surgery in our hospital from April 2018 to October 2020 were selected according to the inclusion and exclusion criteria.According to different treatment options,they were divided into ablation group and resection group and 50 patients were included in each group for LUS-MWA or laparoscopic partial liver resection respectively.The intraoperative factors,postoperative factors,the relevant complications and short-term and long-term survival rate were compared between the two groups to evaluate the clinical efficacy and safety of LUS-MWA in the treatment of HCC.Twenty four possible factors related to tumor progression and postoperative survival were analyzed to explore the correlation with survival.Chi-square test and Mann-Whitney U test were used to analyze and compare the differences of clinical indicators between the two groups.Kaplan-Meier model and Log-rank test were used for univariate analysis to analyze progression-free survival and overall survival.COX proportional hazard model was used for multivariate analysis to analyze the independent predictive factors of tumor progression after ablation and independent prognostic factors of patients′ survivals.ResultsThe technical success rates of the two groups were 96.0%,98.0%,respectively,which two patients in ablation group were incompletely ablation and 1 patient in resection group whose postoperative Alpha-fetoprotein(AFP)level was higher than preoperative level.There were no procedure-related deaths and severe intraoperative complications occurred.Compared between the two groups,the operation time of the ablation group was shorter than that of the resection group,and there was statistically significant difference(125.64±49.16 min vs 227.06±85.86 min,P=0.000).The intraoperative blood loss in the ablation group was less than that of the resection group,and there was significant difference(38.60±47.03 ml vs 283.40±349.17 ml,P=0.000).The blood transfusion rate in the ablation group was 2.0%,and the blood transfusion rate in the resection group was 22.0%.The difference between the two groups was statistically significant(χ~2=9.470,P=0.002).The postoperative feeding time,drainage tube removal time and hospitalization time in the ablation group were shorter than those of the other group and the differences between the groups were statistically significant(P<0.01).There were also significant differences in the direct bilirubin(DB)at first day and first week after surgery(P=0.036,P=0.030),and the same as Alanine Transaminase at first week after surgery(P=0.012).The degree of postoperative liver function injury in the ablation group was more serious than that of the resection group,however,there was no significant difference between the two groups about serum markers of liver function at 1 month after operation(P>0.05).The median progression-free survival time of the two groups were 11.5,19.5 months,respectively,and there was statistically significant difference between the groups(χ~2=10.745,P=0.001).The cumulative overall survival rates at 6,12,24,and 30 months in the ablation group were 96.0%,81.3%,65.1%,and 59.5%,respectively,and the cumulative overall survival rates at 6,12,24,and 30 months in the resection group were98.0%,94.0%,83.5%,71.9%,respectively,and there was no significant difference between the two groups(χ~2=2.900,P=0.089).In univariate analysis,7 of the 22 factors that may be related to tumor progression after LUS-MWA treatment were shown to be statistically significant,which were the treatment method,basic diseases,histological type,portal hypertension,Child-Pugh grade,tumor size,preoperative Alkaline Phosphatase(ALP)level.Multivariate analysis showed that preoperative ALP level,histological type,Child-Pugh grade,tumor size and basic diseases were the independent risk factors affecting tumor progression in patients with HCC undergoing LUS-MWA.Of the24 factors that may be related to patients′ survivals,ten factors were statistically significant,including basic diseases,the Union for International Cancer Control stage,the degree of tumor differentiation,histological type,Child-Pugh grade,tumor size,preoperative ALP level,the degree of postoperative AFP decline,tumor progression,tumor progression time.Multivariate analysis showed that the factors that independently affected the overall survival of patients were histological types,Child-Pugh grade,tumor size,preoperative ALP level,the degree of postoperative AFP decline and tumor progression time.ConclusionsLUS-MWA is a safe and effective method in the treatment of HCC with the advantages of less operation time,less trauma,and quicker recovery than the treatment of surgical resection.Although patients are more prone to have tumor recurrence after LUS-MWA,the long-term efficacy of patients undergoing this way is comparable to surgical resection due to its good repeatability and high patient compliance.It provides a new clinical treatment plan for HCC patients who are not feasible for traditional surgical resection.The independent risk factors for tumor progression after LUS-MWA in HCC include: preoperative ALP level,histological type,Child-Pugh grade,tumor size,basic diseases,while the independent factors influencing the survival and prognosis of HCC patients include histological types,Child-Pugh grade,tumor size,preoperative ALP level,the degree of postoperative AFP decline and tumor progression time.