Ultrasound-guided percutaneous microwave ablation versus cryoablation for treatment of hepatocellular carcinoma on the high-risk location

Abstract

Objective: The aims of this study were to compare the clinical outcomes between ultrasound-guided percutaneous microwave ablation (MWA) and cryoablation (CRA) in patients with hepatocellular carcinoma (HCC) on the high-risk location and to identify the prognostic factors associated with the two treatment methods. Methods: Retrospective study on 120 patients (88 men and 32 women) with one hundred and thirty-four HCCs on the high-risk location in our hospital from April 2014 to March 2018 were reviewed. Sixty-four patients underwent MWA and 56 patients underwent CRA. The treatment outcomes between the two groups were compared, including survival, recurrence, and postoperative complications., Cox regression models were used to analyze the influencing factors of prognosis and postoperative recurrence. Effect of changes in key parameters [overall survival (OS) , recurrence-free survival (RFS) and local tumor progression (LTP) ] was statistically analyzed with the log-rank test. Univariate and multivariate analysis were performed on clinicopathological variables to identify factors affecting intermediate-term outcome. Results: The cumulative OS rates at 1, 3, and 5-years were 85.8%, 63.5% and 63.5%, respectively, in MWA group, and 92.0%, 87.4% and 74.9%, respectively, in CRA group. There were no significant statistical difference (P=0.141) . The cumulative RFS rates at 1, 3, and 5-years were 77.8%, 49.0%, 49.0%, respectively, in MWA group, and 81.4%, 58.5%, 46.8%, respectively, in CRA group. There were no significant statistical difference (P=0.469) . The LTP rates at 3, 6, 9, 12 month were 3.1%, 6.3%, 9.4%, 15.9%, respectively in MWA group, which were higher than those in CRA group (0%, 0%, 3.7%, and 19.0%, respectively) with statistically significant differences (P=0.003) . The major and minor complications in MWA group (6.3%, 82.8%, respectively) were higher than those in CRA goup (0%, 32.1%, respectively) with statistically significant differences. Univariate analysis showed that age (P=0.007) , tumor size (P=0.001) , and CTP grade (P=0.003) were risk factors for OS, and multivariate analysis results showed that age ≥65 years, 3.0-5.0 cm in size and CTP grade B were independently associated with poor OS. 3~5 cm in diameter, multiple tumors and multiple ablation are risk factors for recurrence after ablation. Conclusions: CRA had comparable oncologic outcomes with MWA and could be a safe and effective treatment for HCC on the high-risk location. Key words: Hepatocellular carcinoma; Microwave ablation; Cryoablation; Outcome; High-risk