Percutaneous microwave ablation of 5-6 cm unresectable hepatocellular carcinoma: local efficacy and long-term outcomes

Figures & data

Figure 1. Flowchart of patient selection.

Table 1. Clinical characteristics of the 82 enrolled patients.

Characteristics	Value (n = 82)
Gender
Male/Female	75 (91.5%)/7 (8.5%)
Age (year)*	58.5 ± 11.7 (35-82)
≤65/>65	58 (70.7%)/24 (29.3%)
Aetiology
HBV/HCV	68 (82.9%)/14 (17.1%)
HBV-DNA
Positive/Negative/Absent	31 (37.8%)/37 (45.1%)/14 (17.1%)
TBIL (μmol/L)*	15.8 ± 6.3 (4.7-36.8)
≤17.1/>17.1	56 (68.3%)/26 (31.7%)
DBIL (μmol/L)*	6.3 ± 3.1 (1.6-19.4)
≤7.0/>7.0	60 (73.2%)/22 (26.8%)
ALT (U/L)*	55.7 ± 42.1 (12.3-202.5)
≤40.0/>40.0	40 (48.8%)/42 (51.2%)
ALB (g/L)*	40.4 ± 4.9 (29.1-52.6)
<35.0/≥35.0	13 (15.9%)/69 (84.1%)
GGT (U/L)*	116.3 ± 87.8 (19.0-512.0)
≤50.0/>50.0	21 (25.6%)/61 (74.4%)
AFP (μg/L)
≤20/21-200/>200	32 (39.0%)/23 (28.1%)/27 (32.9%)
PLT (×10^9/L)*	139.8 ± 63.7 (46-377)
<100/≥100	22 (26.8%)/60 (73.2%)
PT (s)*	12.5 ± 1.3 (10.1-17.0)
<13/≥13	30 (36.6%)/52 (63.4%)
Portal hypertension
Present/Absent	42 (51.2%)/40 (48.8%)
Child-Pugh classification
Class A/Class B	63 (76.8%)/19 (23.2%)
Tumour size (cm)*	5.6 ± 0.3 (5.1-6.0)
Tumour location
Favourable/Unfavourable	54 (65.9%)/28 (34.1%)

* Data are means ± SD. Numbers in parentheses describe ranges.

TBIL: Total bilirubin; DBIL: Direct bilirubin; HBV: Hepatic B virus; HCV: Hepatic C virus; ALT: Alanine aminotransferase; ALB: Albumin; GGT: Gamma-glutamyl transpeptidase; AFP: Alpha-fetoprotein; PLT: Platelet; PT: Prothrombin time.

Figure 2. Imaging document of the presence and disappearance of HCC lesions. The MWA-treated subject was a 52-year-old male HCC patient who had HBV-related liver cirrhosis. (A) Arterial phase; (B) Portalvenous phase. Pre-treatment CT images shows a tumour as a 5.4-cm hyperintense nodule on an intense arterial enhancement (A), with an enhancement recession (B). (C) Arterial and (D) portalvenous phase. MRI images obtained at four weeks after treatment show no enhancements inside or beside the ablation zone.

Table 2. Analysis of factors associated with local recurrence.

	Univariate analysis		Multivariate analysis
Variables	X^2	p Values	Risk ratio (95% CI)	p Values
Gender: Male vs. Female	1.798	.180
Age (year): ≤65 vs. >65	6.276	.012	3.302 (1.248–8.737)	.016
Aetiology: HBV vs. HCV	0.324	.569
HBV-DNA: positive vs. negative	0.341	.559
TBIL (μmol/L): ≤17.1 vs. >17.1	1.714	.190
DBIL (μmol/L): ≤7.0 vs. >7.0	0.049	.824
ALT(U/L): ≤40.0 vs. >40.0	1.672	.196
ALB (g/L): <35.0 vs. ≥35.0	0.188	.664
GGT (U/L): ≤50.0 vs. >50.0	0.080	.778
AFP (μg/L): ≤20 vs. 21-200 vs. >200	2.825	.244
PLT (×10^9/L): <100 vs. ≥100	4.151	.042	2.958 (1.123–7.788)	.028
PT (s): <13s vs. ≥13	0.195	.659
Portal hypertension: present vs. absent	1.860	.173
Child-Pugh classification:	5.184	.023	2.657 (1.001–7.052)	.050
Class A vs. Class B
Tumour location:	0.154	.695
Favourable vs. Unfavourable
Local efficacy
Primary technical efficacy vs. residual unablated tumour	0.017	.895

TBIL: Total bilirubin; DBIL: Direct bilirubin; HBV: Hepatic B virus; HCV: Hepatic C virus; ALT: Alanine aminotransferase; ALB: Albumin; GGT: Gamma-glutamyl transpeptidase; AFP: Alpha-fetoprotein; PLT: Platelet; PT: Prothrombin time; CI: Confidence interval.

Figure 3. Recurrence-free survival curves after MWA treatment.

Figure 4. Overall survival curves after MWA treatment.

Table 3. Analysis of factors associated with overall survival.

	Univariate analysis		Multivariate analysis
Variables	X^2	p Values	Risk ratio (95% CI)	p Values
Gender: male vs. female	0.033	.857
Age (year): ≤65 vs. >65	3.890	.049	0.321 (0.738–2.534)	.321
Aetiology: HBV vs. HCV	1.551	.213
HBV-DNA: positive vs. negative	1.349	.245
TBIL (μmol/L): ≤17.1 vs. >17.1	0.058	.810
DBIL (μmol/L): ≤7.0 vs. >7.0	0.214	.644
ALT(U/L): ≤40.0 vs. >40.0	0.805	.370
ALB (g/L): <35.0 vs. ≥35.0	0.000	.996
GGT (U/L): ≤50.0 vs. >50.0	0.014	.906
AFP (μg/L): ≤20 vs. 21-200 vs. >200	10.396	.006	1.374 (0.979–1.927)	.066
PLT (×10^9/L): <100 vs. ≥100	0.332	.565
PT (seconds): <13 vs. ≥13	0.812	.368
Portal hypertension: present vs. absent	1.589	.208
Child-Pugh classification:	40.018	<.001	5.681 (2.950–10.939)	<.001
Class A vs. Class B
Tumour location:	5.025	.025	0.498 (0.248–0.997)	.049
Favourable vs. unfavourable
Local efficacy
Primary technical efficacy vs. residual unablated tumour	0.169	.681
Local recurrence: yes vs. no	21.043	<.001	2.827 (1.470–5.436)	.002
Distant recurrence: yes vs. no	3.569	.059
Treatment for recurrence	0.218	.869
PMWA vs. TACE vs. Radiotherapy

TBIL: Total bilirubin; DBIL: Direct bilirubin; HBV: Hepatic B virus; HCV: Hepatic C virus; ALT: Alanine aminotransferase; ALB: Albumin; GGT: Gamma-glutamyl transpeptidase; AFP: Alpha-fetoprotein; PLT: Platelet; PT: Prothrombin time.