Clinical Research On The Therapy Of Hepatocellular Carcinoma Based On TACE And Ultrasound Guided Microwave Ablation

ObjectiveTo compare retrospectively the efficacy of transcatheter arterial chemoembolization(TACE)plus ultrasound guided percutaneous microwave ablation(MWA)(TACE-MWA)with TACE alone for hepatocellular carcinoma(HCC)and recurrent hepatocellular carcinoma(RHCC)after initial surgery by propensity score matching(PSM).MethodsFrom 2014.1 to 2019.10,113 patients with HCC who received either TACE alone(n=55)or TACE-MWA(n=58)as a firest-line treatment,and 107 patients with RHCC who underwent TACE alone(n=60)or TACE-MWA(n=47)after initial surgery in our hospital were inclouded.Outcomes of TACE–MWA and TACE groups were compared.Overall survival(OS)and progression-free survival(PFS)were calculated.Univariate and multivariate analyses were performed to identify prognostic factors.PSM was used to correct the covariate differences between the two groups.ResultsBefore PSM,in HCC patients,cumulative 5-year OS rates in TACE and TACE-MWA groups were 10.5%,35.1%(P=0.001),and the 5-year PFS rates were 0%,15.0%(P=0.000),respectively.After PSM,cumulative 5-year OS rates were 10.4%,26.4%(P=0.044),and the 5-year PFS rates were 0%,15.5%(P=0.010)for the groups of TACE alone and TACE-MWA,respectively.The tested indicators in TACE-MWA group,including OS and PFS,were totally superior to TACE group.In subgroup analysis,TACE–MWA also showed better OS rates and PFS rates in patients with the absence of portal vein tumor thrombus(PVTT)and tumor number ≤3.Cox regression analysis indicated that,PVTT,tumor size >5cm and tumor number >3 were independent unfavorable predictors for OS;TACE,PVTT,tumor size >5cm,tumor number >3,ALT >50U/L and ALB <35g/L were independent prognostic factors of PFS.Before PSM,in RHCC patients,cumulative 5-year OS rates were 17.7%,35%(P=0.027),and the 5-year PFS rates were 13.4%,28.9%(P=0.029)for TACE and TACE-MWA groups,respectively.After PSM,cumulative 5-year OS rates were 15.3%,39.5%(P=0.038),and the 5-year PFS rates were 12.6%,31.2%(P=0.049)for the groups of TACE and TACE-MWA,respectively.The tested indicators in TACE-MWA group,including OS and PFS,were totally superior to TACE group.Subgroup analysis showed that patients with time to recurrence(TTR)>1 year and the absence of microvascular invasion(MVI)could benefit more from TACE-MWA than TACE.Multivariate analysis showed that MVI positive and recurrent tumor diameter >3cm were unfavorable predictors for OS and PFS.Conclusion1.For HCC patients,the effect of TACE-MWA is better than TACE.For patients with PVTT negative and tumor number ≤3,TACE-MWA is more recommended.Therapies,PVTT,tumor size,tumor number,ALB and ALT level can impact the long-term effect of HCC obviously.2.For patients with RHCC,when TTR >1 year and MVI negative,the efficacy of TACE-MWA is superior to TACE alone.Moreover,positive MVI and tumor diameter >3 cm could harm the long-term curative effect.