Small single perivascular hepatocellular carcinoma: comparisons of radiofrequency ablation and microwave ablation by using propensity score analysis

Ping Liang,Xiao-Ling Yu,Jinhua Huang,Fang-Yi Liu,Wang-Zhong Li,Chao An,Zhi-Mei Huang,Jie Yu,Song-Song Wu,Yu-Zhi Han

doi:10.1007/s00330-020-07571-5

Abstract

ObjectivesWe aimed to compare the therapeutic outcomes of radiofrequency ablation (RFA) and microwave ablation (MWA) as first-line therapies in patients with small single perivascular hepatocellular carcinoma (HCC).MethodsA total of 144 eligible patients with small (≤ 3 cm) single perivascular (proximity to hepatic and portal veins) HCC who underwent RFA (N = 70) or MWA (N = 74) as first-line treatment were included. The overall survival (OS), disease-free survival (DFS), and local tumor progression (LTP) rates between the two ablation modalities were compared. The inverse probability of treatment weighting (IPTW) method was used to reduce selection bias. Subgroup analysis was performed according to the type of hepatic vessels.ResultsAfter a median follow-up time of 38.2 months, there were no significant differences in OS (5-year OS: RFA 77.7% vs. MWA 74.6%; p = 0.600) and DFS (5-year DFS: RFA 24.7% vs. MWA 40.4%; p = 0.570). However, a significantly higher LTP rate was observed in the RFA group than the MWA group (5-year LTP: RFA 24.3% vs. MWA 8.4%; p = 0.030). IPTW-adjusted analyses revealed similar results. The treatment modality (RFA vs. MWA: HR 7.861, 95% CI 1.642–37.635, p = 0.010) was an independent prognostic factor for LTP. We observed a significant interaction effect of ablation modality and type of peritumoral vessel on LTP (p = 0.034). For patients with periportal HCC, the LTP rate was significantly higher in the RFA group than in the MWA group (p = 0.045). However, this difference was not observed in patients with perivenous HCC (p = 0.116).ConclusionsIn patients with a small single periportal HCC, MWA exhibited better tumor control than RFA.Key Points• Microwave ablation exhibited better local tumor control than radiofrequency ablation for small single periportal hepatocellular carcinoma.• There was a significant interaction between the treatment effect of ablation modality and type of peritumoral vessel on local tumor progression.• The type of peritumoral vessel is vital in choosing ablation modalities for hepatocellular carcinoma.

Highlights

Surgical resection (SR), liver transplantation, and local-region ablation have been recommended as first-line therapeutic options for patients with early-stage hepatocellular carcinoma (HCC) [1, 2]
A total of 144 patients with small single perivascular HCC treated with radiofrequency ablation (RFA) (n = 70) or microwave ablation (MWA) (n = 74) as first-line therapy were enrolled in the study
Standardized mean differences in the unweighted cohort showed that significant differences were observed in cirrhosis, tumor size, alanine aminotransferase, aspartate aminotransferase, total bilirubin, and albumin

Summary

Introduction

Surgical resection (SR), liver transplantation, and local-region ablation have been recommended as first-line therapeutic options for patients with early-stage hepatocellular carcinoma (HCC) [1, 2]. Topographical factors can impede the therapeutic effectiveness of ablation therapy [9,10,11]. These factors include noduleabutting organs such as the gastrointestinal tract, diaphragm, or major vessels. These organs are regarded as “challenging locations.”. Compared with MWA, RFA treatment in perivascular HCC may result in a cold zone due to the slow warming of the target area, and heat dissipation result from rapid blood flow. The local tumor control exhibited by RFA in perivascular HCC patients has not been well elucidated [14]

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