Microwave ablation versus resection for hepatocellular carcinoma within the Milan criteria: a propensity-score analysis.

ABSTRACT:

Background

Whether the efficient heat-generating mechanism of microwave ablation (MWA) is comparable with resection (RES) in treating hepatocellular carcinoma (HCC) remains unclear.

Methods

This retrospective cohort study comprised 126 and 1183 patients with HCC meeting the Milan criteria who received MWA or RES between 2002 and 2017. We compared 5-year overall survival (OS) and recurrence-free survival (RFS) using both propensity-score matching (PSM) and inverse-probability-of-treatment-weighting (IPW) analysis and investigated the prognostic factors with multivariate Cox analysis.

Results

After PSM (1:2), although MWA (n?=?116) offered decreased 5-year RFS (30.6% versus 57.5%, p?n?=?212), both treatments provided similar 5-year OS (82.2% versus 80.5%, p?=?0.360) because most patients with intrahepatic recurrence remained eligible for repeat treatments; similar results were found in the IPW analysis. Additionally, the comparable efficacy of MWA and RES was consistent across all subgroups: those with solitary HCC???3.0?cm or >3.0?cm, or multifocal HCCs within the Milan criteria, patients with liver function of albumin-bilirubin grade 1 or 2, and older (?60?years) or younger (<60?years) patients. Multivariate Cox analysis confirmed that no difference was seen between MWA and RES in OS (hazard ratio?=?0.85; p?=?0.581) in the overall population; similar results were obtained in the propensity-score-matched and IPW cohorts.

Conclusions

Compared with RES, MWA offered worse RFS for HCC within the Milan criteria; however, both treatments provided equivalent long-term OS because most patients with intrahepatic recurrence remained eligible for repeat treatments.

SUBMITTER: Liu W 

PROVIDER: S-EPMC6740202 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature