Korean J Radiol.  2018 Apr;19(2):237-246. 10.3348/kjr.2018.19.2.237.

Comparison of the Efficacy and Prognostic Factors of Transarterial Chemoembolization Plus Microwave Ablation versus Transarterial Chemoembolization Alone in Patients with a Large Solitary or Multinodular Hepatocellular Carcinomas

• Zheng L
• Li HL
• Guo CY
• Luo SX

• KMID: 2404920
• DOI: http://doi.org/10.3348/kjr.2018.19.2.237

Abstract

OBJECTIVE
To evaluate the efficacy and prognostic factors associated with transcatheter arterial chemoembolization (TACE) combined with microwave ablation (MWA) versus TACE alone for a large solitary or multinodular hepatocellular carcinomas (HCCs).
MATERIALS AND METHODS
This retrospective study involved 258 patients with a large solitary or multinodular HCCs (not more than 10 tumors) who underwent TACE + MWA (n = 92) or TACE alone (n = 166) between July 2011 and April 2015. Local tumor control, survival outcomes, and complications were compared between the two groups. Prognostic factors for time to progression (TTP) and overall survival (OS) were evaluated by univariate and multivariate analyses.
RESULTS
The median duration of follow-up was 21.2 months (range, 4-45 months). The median TTP and OS were 12.5 months and 26.6 months, respectively, for the TACE + MWA group and 6.7 months and 17.1 months, respectively, for the TACE group (p < 0.001). The 1-, 2-, and 3-year OS rates were 85.9, 59.8, and 32.6%, respectively, for the TACE + MWA group and 59.0, 40.4, and 11.4%, respectively, for the TACE group (p < 0.001). The corresponding recurrence rates were 47.8, 78.3, and 94.6% for the TACE + MWA group, respectively, and 74.7, 96.4, and 97.6%, respectively, for the TACE group (p < 0.001). Logistic regression analyses showed that the treatment method, tumor size, and tumor number were significant prognostic factors for TTP and OS.
CONCLUSION
TACE + MWA appears to have more advantages compared to TACE in prolonging OS, with a satisfactory TTP, for inpatients with solitary large or multinodular HCCs. Treatment method, tumor size, and tumor number are significant prognostic factors for TTP and OS. Further randomized, multi-center, prospective trials are required to confirm the findings of this study.

Keyword

Hepatocellular carcinoma; Transarterial chemoembolization; Microwave ablation; Combination therapy; Large solitary; Multinodular

MeSH Terms

Carcinoma, Hepatocellular*
Follow-Up Studies
Humans
Inpatients
Logistic Models
Methods
Microwaves*
Multivariate Analysis
Prospective Studies
Recurrence
Retrospective Studies

Figure

• 

  Fig. 1 Study flow chart showing selection of 258 patients who were finally included in study.Flow diagram of progress of 258 patients through enrolment, allocation, follow-up and data analysis phases of our study. ECOG PS = Eastern Cooperative Oncology Group Performance Status, HCC = hepatocellular carcinoma, MWA = microwave ablation, RFA = radiofrequency ablation, TACE = transcatheter arterial chemoembolization

• 

  Fig. 2 57-year-old man with multinodular HCC who underwent TACE + MWA combination treatment.A. Non-enhanced CT imaging revealed lipiodol deposits in multinodular HCC (arrowheads). B. CT image during MWA procedure showing antenna has reached opposite edge of tumor via its center (arrowheads). C. Contrast-enhanced MRI image (6 months post-ablation therapy) showing homogeneous hypointense non-enhancing areas (ablation beds, arrowheads) without residual enhancement, denoting successful ablation and complete response.

• 

  Fig. 3 58-year-old man with HCC who underwent CT-guided MWA after TACE.A. Diagnosis of HCC was based on findings on contrast-enhanced MRI and high AFP concentration (563 ng/mL). Lesion measures 13 cm in longest diameter (arrowheads). B. After TACE procedure, CT-guided MWA was performed to control residual tumor in target lesion (arrowheads). Patient underwent TACE + MWA combination therapy twice. C. Contrast-enhanced MRI scan 6 months after combination treatment showing non-enhancing thermal scar (arrowheads) at site of original tumor and no intrahepatic recurrence. AFP = alpha-fetoprotein

• 

  Fig. 4 Tumor progression rate (A) and overall survival rate (B) of patients in TACE + MWA and TACE alone groups.

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