Percutaneous microwave ablation versus surgical resection for ovarian cancer liver metastasis

Figures & data

Figure 1. Flow diagram shows exclusion criteria in patients with ovarian cancer liver metastasis (OCLM).

Figure 2. A 55-year-old woman with solitary ovarian cancer liver metastasis (OCLM). (A) Contrast-enhanced CT shows ovarian cancer (OC) lesions (arrow) located on left ovary in the arterial phase; (B) Contrast-enhanced CT shows OCLM lesion (*, arrow) located on S6 in liver; (C) Contrast-enhanced CT shows OC lesions removed by cytoreductive surgery (CRS) after 1 month (arrow); (D) Contrast-enhanced CT shows OCLM lesion (*, arrow) underwent surgical resection after 4 months.

Figure 3. A 48-year-old woman with solitary ovarian cancer liver metastasis (OCLM). (A) Contrast-enhanced CT shows ovarian cancer (OC) lesions (arrow) located on ovary in the arterial phase; (B) Contrast-enhanced CT shows OCLM lesion (*, arrow) located on S7 in liver; (C) Contrast-enhanced CT shows OC lesions removed by cytoreductive surgery (CRS) after 3 months (arrow); (D) Contrast-enhanced CT shows OCLM lesion (*, arrow) underwent microwave ablation (MWA) after 2 months.

Table 1. Characteristics of patients with OCLM.

No./age (y)	Histologic type	Previous treatments	PS	CTP grade	TS (cm)	TN	TL	Detection of LM
SR group
1/55	Papillary serous cystadenocarcinoma	CRS + chemotherapy	0	A	2.5	1	S6	Metachronous
2/46	Mucus papillary cystadenocarcinoma	CRS + chemotherapy	0	A	5	2	S6, S7	Metachronous
3/33	Mucus papillary cystadenocarcinoma	CRS + chemotherapy	0	A	3	2	S5	Metachronous
4/60	Mucus papillary cystadenocarcinoma	CRS + chemotherapy	0	A	5	1	S4, S5, S8	Metachronous
5/40	Endometrioid adenocarcinoma	Chemotherapy	1	A	5	1	S5, S6	Metachronous
6/55	Clear cell adenocarcinoma	CRS + chemotherapy	0	B	3	4	S2, S3	Synchronous
7/21	Germinoma	CRS + chemotherapy	0	B	3.5	1	S4	Synchronous
8/45	Papillary serous cystadenocarcinoma	CRS + chemotherapy	0	A	2	1	S7	Metachronous
9/27	Papillary serous cystadenocarcinoma	CRS + chemotherapy	0	A	2	2	S8	Metachronous
10/40	Mucus papillary cystadenocarcinoma	CRS + chemotherapy	0	A	5	1	S4, S5, S8	Metachronous
11/54	Mucus papillary cystadenocarcinoma	CRS + chemotherapy	0	A	2	1	S5	Metachronous
12/32	Papillary serous cystadenocarcinoma	CRS + chemotherapy	1	A	1.5	2	S6	Metachronous
13/53	Papillary serous cystadenocarcinoma	CRS + chemotherapy	0	A	1.5	1	S7	Metachronous
14/44	Papillary serous cystadenocarcinoma	Chemotherapy	0	A	3	1	S6	Metachronous
MWA group
1/38	Mucus papillary cystadenocarcinoma	Chemotherapy	0	A	2	3	S5, S6	Metachronous
2/41	Papillary serous cystadenocarcinoma	CRS + chemotherapy	0	A	0.8	2	S6	Metachronous
3/59	Papillary serous cystadenocarcinoma	CRS + chemotherapy	0	A	2.3	1	S7	Synchronous
4/48	Mucus papillary cystadenocarcinoma	CRS + chemotherapy	0	A	1.3	1	S5	Metachronous
5/51	Mucus papillary cystadenocarcinoma	CRS + chemotherapy	0	A	1.2	1	S8	Metachronous
6/48	Clear cell adenocarcinoma	Chemotherapy	0	A	3.8	2	S8	Metachronous
7/56	Papillary serous cystadenocarcinoma	CRS + chemotherapy	0	A	2	1	S6	Metachronous
8/49	Papillary serous cystadenocarcinoma	CRS + chemotherapy	0	A	1.8	2	S6	Metachronous
9/55	Papillary serous cystadenocarcinoma	CRS + chemotherapy	1	A	3.9	1	S8	Metachronous
10/50	Papillary serous cystadenocarcinoma	CRS + chemotherapy	0	A	1.4	2	S8	Synchronous
11/52	Papillary serous cystadenocarcinoma	CRS + chemotherapy	0	B	1.5	1	S7	Metachronous
12/48	Mucus papillary cystadenocarcinoma	CRS + chemotherapy	0	A	3.5	1	S6	Metachronous
13/65	Mucus papillary cystadenocarcinoma	CRS + chemotherapy	0	A	2	2	S7	Metachronous
14/57	Papillary serous cystadenocarcinoma	CRS + chemotherapy	0	A	5	1	S5	Metachronous
15/44	Papillary serous cystadenocarcinoma	CRS + chemotherapy	0	A	3.1	1	S4	Metachronous

OCLM: ovarian cancer liver metastasis; SR: surgical resection; MWA: microwave ablation; PS: performance status; TS: tumor size; TN: tumor number; TL: tumor location; CRS: cytoreductive surgery.

Table 2. Comparation of treatment parameters and postoperative outcomes between MWA and SR group.

Characteristic	MWA (n = 16)	SR (n = 14)	p Value
Mean total surgical time (min) ± SD	39.2 ± 14.8	110.6 ± 33.7	<.001
Median estimated blood loss (mL) ± SD	7.5 ± 3.2	79.6 ± 13.2	<.001
Blood transfusion	0 of 15 (0)	1 of 14 (4.5)	.276
Mean postoperative hospitalization (d) ± SD	4.2 ± 0.9	14.5 ± 5.5	<.001
Cost (yuan) ± SD	22712.3 ± 2914.2	30064.9 ± 4562.3	.015
Major complications	0 of 15 (0)	3 of 14 (21.4)	.593
LTP	3 of 15 (20.0)	5 of 14 (35.7)	.889
Death	9 of 15 (60.0)	5 of 14 (35.7)	.198

SR: surgical resection; MWA: microwave ablation; SD: standard deviation.

Table 3. Serum CA-125 levels for all the patients at multiple time points.

Group	Mean CA-125 values ± SD (U/mL)
	Post-CRS	Post-CRS	Pre-MWA	Post-MWA
SR	923.52 ± 456.25	17.52 ± 7.62	18.23 ± 8.23	12.11 ± 5.82
MWA	776.15 ± 528.32	16.92 ± 3.27	18.11 ± 6.28	14.82 ± 4.19

SR: surgical resection; MWA: microwave ablation; CRS: cytoreductive surgery.

Table 4. Preoperative and postoperative liver function between MWA group and SR group.

Parameter	Pre-operation			Post-operation
	MWA group (n = 15)	SR group (n = 14)	p Value	MWA group (n = 15)	SR group (n = 14)	p Value
Albumin (μmol/L)	35.7 (34.2–37.8)	35.2 (33.6–37.2)	.782*	35.3 (33.4–36.1)	34.2 (32.2–37.4)	.143*
Total bilirubin (μmol/L)	16.8 (4.2–31.9)	17.5 (3.6–30.6)	.425*	17.3 (4.8–32.3)	17.1 (3.8–37.1)	.615*
ALT (U/L)	42.8 (9.6–98.6)	44.0 (5.6–63.5)	.324*	54.8 (19.3–119.6)	61.1 (18.2–98.7)	.032*
AST (U/L)	43.7 (18.6–112.3)	47.8 (17.2–89.5)	.419*	53.9 (18.6–153.4)	62.7 (17.7–128.2)	.228*

Unless otherwise indicated, numbers out parentheses are median value and numbers in parentheses are the range.

MWA: microwave ablation; SR: surgical resection; ALT: alanine transaminase; AST: aspartate transaminase.

* Student t test.

Figure 4. Graphs show cumulative OS and LRFS rates in patients with OCLM. (A) comparation of cumulative 1-, 3-, 5-years OS between SR group and MWA group; (B) comparation of cumulative 1-, 3-, 5-years LRFS between SR group and MWA group.

Table 5. Multivariate analysis of prognostic factors with OS.

Variable	β level	SE	Wald	p Value	OR	95% Confidence interval
Age	3.921	0.672	1.926	.001	6.178	1.734	11.293
Intrahepatic tumor diameter	2.773	0.711	1.823	.442	3.287	0.578	5.558
Intrahepatic tumor number	2.690	0.570	2.102	.279	1.116	0.462	3.982
Treatment modality	1.827	0.914	w2.562	.662	2.725	0.559	3.153

OS: overall survival.

Table 6. Multivariate analysis of prognostic factors with LTP.

Variable	β level	SE	Wald	p Value	OR	95% Confidence interval
Age	3.231	0.087	1.672	.418	2.623	0.562	2.432
Intrahepatic tumor diameter	2.287	0.721	1.823	.005	5.316	2.812	9.273
Intrahepatic tumor number	3.281	0.627	2.223	.001	4.285	1.273	8.462
Treatment modality	1.039	1.123	1.275	.823	1.234	0.623	3.234

LTP: local tumor progression.