Assessment of the treatment mainly using intraoperative microwave coagulo-necrotic therapy (MCN) for bilobar multiple hepatocellular carcinoma

Abstract

Purpose: Embolization or chemotherapy is generally recommended for hepatocellular carcinoma (HCC) patients with 4 or more tumors. However, we consider intraoperative microwave coagulo-necrotic therapy (MCN) a useful treatment method with similar local management effects as hepatic resection (HR) and have aggressively used even for multiple bilobar HCC. Now we evaluated therapeutic results and report on the usefulness of this treatment. Patients and methods: Among a total of 2877 HCC patients treated surgically at our department from 1994 to 2014, 1182 patients were newly diagnosed with HCC. Among these, 174 patients with 4 or more HCC tumors in both lobes were included. Overall survival (OS), disease-free survival (DFS), liver function, and tumor features were evaluated. MCN was performed in 151 patients, HR+MCN in 21, and HR in 2. Results: The mean age of 174 patients was 67.4 years and 77.6% had hepatitis C. The mean tumor diameter of the main nodule was 29.6 mm. The 3-, 5-, and 10-year OS (%) of these patients were 72.9, 44.7, and 22.0, respectively. The 5 year-OS in Child-Pugh grade (CP) -A 126 patients was 50.0% and was significantly higher than that in CP-B patients (p = 0.0016). In the evaluation of individual markers, the 3-year/5-year OS of patients with PIVKA-II < 400 (78.3/49.4%) was significantly favorable than those with PIVKA-II ≥ 400 (35.2/17.6%) (P = 0.0002). Conclusion: MCN-based treatment strategies are useful in multiple HCC. Favorable liver function (CP-A) is necessary for long-term survival. Especially, surgical treatment should be selected for patients with PIVKA-II < 400.