Hepatocellular carcinoma abutting large vessels: comparison of four percutaneous ablation systems

Figures & data

Figure 1. Flow-chart. Among the 914 HCC treated, 352 were included. After matching, 40 HCC for each treatment group were retained for further analysis (N = 160).

Figure 2. Illustration of the differences between the different ablation devices used to treat HCC abutting large vessel: (A) microwaves ablation; (B) monopolar RFA using a multi-tined electrode; (C) multi-bipolar radiofrequency ablation; and (D) cluster RFA.

Table 1. Baseline characteristics of patients and nodules treated either by single-applicator monopolar, cluster-RF, multi-bipolar radiofrequency, or microwave ablation.

	Monopolar RFAN = 40 (%)	Cluster RFAN = 40 (%)	No-touch multi-bipolar RFAN = 40 (%)	Microwave ablationN = 40 (%)	p Value
Age (years)	66 (61–75)	65 (58–74)	69 (61–74)	69 (61–75)	0.766
Male, n (%)	33 (82.5)	34 (85)	36 (90)	37 (92.5)	0.577
Cirrhosis aetiologies, n (%)
Alcohol abuse	18 (45)	21 (52.5)	23 (57.5)	28 (70)	–
NASH	7 (17)	8 (20)	10 (25)	4 (10)	–
Hepatitis C virus	15 (38)	11 (27.5)	6 (15)	7 (17.5)	–
Hemochromatosis	0 (0)	0 (0)	1 (2.5)	1 (2.5)	–
Child-Pugh A, n (%)	37 (92.5)	35 (87.5)	39 (97.5)	40 (100)	0.08
Platelet count	110 (83–136)	129 (59–241)	123 (80–175)	116 (87–147)	0.859
Alpha-fetoprotein serum level (categorised)
≤10 ng/ml	24 (60)	24 (60)	24 (60)	24 (60)	1
>10 ng/ml	16 (40)	16 (40)	16 (40)	16 (40)
Tumor size (range)	2.1 (1–3.9)	2 (1–4)	2.3 (1–4.6)	2.25 (1–4.7)	0.107
Tumour size, n (%)
≤30 mm	35 (87.5)	35 (87.5)	35 (87.5)	35 (87.5)	1
>30 mm	5 (12.5)	5 (12.5)	5 (12.5)	5 (12.5)
Vessels type, n (%)
Portal vein	27 (67.5)	16 (40)	22 (55)	18 (45)	0.361
Hepatic vein	11 (27.5)	22 (55)	18 (45)	20 (50)
Vena cava	2 (5)	2 (5)	0 (0)	2 (5)
Vessel diameter ≥10 mm, n (%)	3 (7.5)	3 (7.5)	3 (7.5)	3 (7.5)	1

Figure 3. Comparison of overall local tumour progression between monopolar RFA group (N = 40), MWA group (N = 40), Cluster-RFA group (N = 40) and multi-bipolar group (N = 40). Overall local tumour progression includes primary failure and local tumour progression. mbpRFA: multi-bipolar radiofrequency ablation.

Table 2. Predictive factors of overall local tumour progression (LTP and primary treatment failure).

Variable	Univariate analysis		Multivariate analysis
	p	Hazard ratio (95% CI)	p	Hazard ratio (95% CI)
Age (years)	0.695	0.993 (0.959–1.028)	–	–
Sex (male)	0.149	1.841 (0.804–4.217)	–	–
Prior treatment (yes vs. no)	0.490	1.292 (0.623–2.677)	–	–
Non-viral hepatitis	0.620	0.821 (0.377–1.787)	–	–
Child A	0.370	0.581 (0.177–1.902)	–	–
Platelet count <100 G/L	0.723	1.134 (0.563–2.284)	–	–
AFP >10 ng/ml	0.982	1.007 (0.515–1.969)	–	–
Tumor size	0.048	1.446 (1.003–2.085)	–	–
Tumor biopsy	0.236	1.610 (0.731–3.546)	–	–
Sub-capsular HCC (yes vs. no)	0.840	0.917 (0.399–2.107)	–	–
Vessel ≥10mm	0.013	3.343 (1.284–8.702)	0.009	3.886 (1.401–10.8)
Portal vein (vs. hepatic vein)	0.248	1.510 (0.750–3.038)	–	–
Ablation techniques
SA-RFA (vs. mbp)	0.073	2.568 (0.915–7.206)	0.043	2.937 (1.033–8.352)
SA-MWA (vs. mbp)	0.023	3.431 (1.182–9.956)	0.024	3.514 (1.176–10.49)
Cluster-RFA (vs. mbp)	0.824	1.144 (0.348–3.763)	0.983	1.012 (0.306–3.352)
SA-MWA (vs. SA-RFA)	0.653	1.210 (0.526–2.779)	0.673	1.196 (0.520–2.750)
Cluster-RFA (vs. SA-RFA)	0.100	0.442 (0.167–1.168)	0.040	0.344 (0.125–0.950)
Cluster-RFA (vs. SA-MWA)	0.053	0.365 (0.131–1.013)	0.021	0.288 (0.099–0.832)

HCC: hepatocellular carcinoma; RFA: radiofrequency ablation; MWA: microwave ablation; mbp: multi-bipolar.

Bold values indicate values with p < 0.05.

Figure 4. Comparison of overall local tumour progression between single-applicator group (N = 80) and multi-applicator group (N = 80). Overall local tumour progression includes primary RFA failure and local tumour progression.