Microwave ablation shows similar survival outcomes compared with surgical resection for hepatocellular carcinoma between 3 and 5 cm

Figures & data

Figure 1. Patient selection. HCC: hepatocellular carcinoma; TACE: transcatheter arterial chemoembolization; RFA: radiofrequency ablation; WMA: wave microwave ablation.

Table 1. baseline characteristics of the total cohort and PSM cohort for HCC up to 5 cm.

Variables	Total cohort				PSM cohort
	MWA group (n = 93)^a	SR group (n = 300)^a	p-value	SMD	MWA group (n = 80)^a	SR group (n = 80)^a	p-value	SMD
Age	58 (49–66)	57 (50–62)	0.074	0.273	58 (48–66)	57 (51–64)	0.626	0.14
Male^b	72 (77.4%)	260 (86.7%)	0.031	0.24	63 (78.8%)	69 (86.3%)	0.212	0.20
Antiviral treatment^b	57 (61.3%)	163 (54.3%)	0.238	0.14	48 (60%)	53 (66.3%)	0.413	0.13
Child-Pugh class A^b	81 (87.1%)	293 (97.7%)	<0.001	0.41	72 (90.8%)	74 (92.5%)	0.576	0.06
Liver cirrhosis^b	72 (77.4%)	218 (72.7%)	0.363	0.11	60 (75%)	63 (78.8%)	0.574	0.09
Portal hypertension^b	50 (53.8%)	141 (47.0%)	0.254	0.14	40 (50%)	40 (50%)	1	0
MELD score	3.7 (1.80–6.1)	5.2 (2.8–6.9)	0.024	0.18	3.51 (1.63–6.00)	4. 8 (2.4–7.0)	0.097	0.14
ALT (U/L)	34.0 (24.0–47.8)	33.0 (22.0–51.0)	0.719	0.11	34.0 (24.0–43.8)	35 (24.3–55.0)	0.494	0.18
AST (U/L)	35.5 (26.0–52.0)	33.0 (25.0–46.0)	0.294	0.097	34.5 (26.0–49.8)	33.0 (27.0–47.0)	0.95	0.1
AFP (U/L)	24.7 (3.7–137.1)	22.8 (4.2–215.7)	0.644	0.13	24.7 (3.5–143.9)	18.23 (5.2–166.)	0.673	0.07
Maximum tumor diameter (cm)	2.8 (2.0–3.6)	3.3 (2.5–4.0)	<0.001	0.47	2.8 (2–3.8)	3.0 (2.3–4.0)	0.143	0.24
0–3 cm^b	58 (62.4%)	138 (46%)	0.006	0.33	49 (61.25%)	47 (58.75%)	0.747	0.05
3–5 cm^b	35 (37.6%)	162 (54%)			31 (39.75%)	33 (41.25%)
Tumor number^b			<0.001	0.39			0.593	0.09
Single	64 (68.8%)	255 (85%)			60 (75%)	57 (71.3%)
Multiple	29 (31.2%)	45 (15%)			20 (25%)	23 (38.7%)

ALT: alanine aminotransferase; AST: aspartate aminotransferase; AFP: alpha fetoprotein; MELD: model for end-stage liver disease; PSM: propensity score matching; SMD: standardized mean difference.

^a Except where indicated, data are medians, with interquartile ranges in parentheses.

^b Data are numbers of patients, with percentages in parentheses.

Figure 2. Overall survival and progression-free survival curves of patients with hepatocellular carcinoma ≥ 3 cm who underwent microwave ablation or resection. There were no significant differences in overall survival curves (A) and progression free survival curves (B) between MWA group and SR group in total cohort for hepatocellular carcinoma ≥ 3 cm (p = 0.548, p = 0.306). And there were no significant differences in overall survival curves (C) and progression-free survival curves (D) between MWA group and SR group in PSM cohort for hepatocellular carcinoma ≥ 3 cm (p = 0.457, p = 0.397).

Figure 3. Overall survival and progression-free survival curves of patients with hepatocellular carcinoma ≤ 5 cm who underwent microwave ablation or resection. There were no significant differences in overall survival curves (A) and progression free survival curves (B) between MWA group and SR group in total cohort for hepatocellular carcinoma ≤ 5 cm (p = 0.879, p = 0.932). And there were no significant differences in overall survival curves (C) and progression-free survival curves (D) between MWA group and SR group in PSM cohort for hepatocellular carcinoma ≤ 5 cm (p = 0.965, p = 0.801).

Table 2. Subgroup analysis for the total cohort and the PSM cohort.

Subgroup	Mean OS time (years)		5-years OS		p-value	Mean PFS time (years)		5-years PFS		p-value
	MWA	SR	MWA	SR		MWA	SR	MWA	SR
Total cohort
Tumor number
Single (n = 319)	7.76	7.57	73.9%	69.8%	0.609	4.73	3.88	38.9%	34.4%	0.379
2–3 (n = 74)	5.66	6.6	67.1%	54.0%	0.971	2.2	2.51	21.7%	16.8%	0.507
ALBI grade
Grade 1 (n = 183)	6.89	7.66	70.6%	69.1%	0.927	2.88	3.85	24.3%	34.7%	0.402
Grade 2 (n = 207)	7.34	7.10	72.0%	65.8%	0.796	4.62	3.56	41.6%	29.5%	0.440
PSM cohort
Tumor number
Single (n = 117)	7.93	8.14	76.0%	76.6%	0.889	4.99	4.42	41.7%	40.7%	0.685
2–3 (n = 43)	5.50	6.81	67.1%	59.5%	0.998	2.37	2.83	30.5%	22.3%	0.452
ALBI grade
Grade 1 (n = 66)	7.62	7.59	80.7%	67.5%	0.311	3.18	4.27	28.4%	38.4%	0.730
Grade 2 (n = 90)	7.47	7.79	70.9%	74.9%	0.574	5.05	4.05	47.9%	35.1%	0.628

ALBI: albumin–bilirubin; MWA: microwave ablation; OS: overall survival; PFS: progression-free survival; PSM: propensity score matching; SR: surgical resection.

Table 3. Factors associated with OS of the total cohort and the PSM cohort for HCC up to 5 cm.

Variables	Total cohort				PSM cohort
	Univariate analysis		Multivariate analysis		Univariate analysis		Multivariate analysis
	HR (95%CI)	p-value	HR (95%CI)	p-value	HR (95%CI)	p-value	HR (95%CI)	p-value
MWA vs SR	0.97 (0.61–1.53)	0.88	0.801 (0.482–1.332)	0.393	0.986 (0.523–1.858)	0.965	0.1–076 (0.560–2.066)	0.826
Age (per year)	1.026 (1.01–1.05)	0.013	1.029 (1.007–1.051)	0.01	1.006 (0.975–1.039)	0.699	1.005 (0.971–1.040)	0.792
Gender (male)	1.50 (0.824–2.737)	0.184	1.416 (0.749–2.678)	0.285	1.521 (0.594–3.889)	0.382	1.218 (0.448–3.314)	0.699
Size (per cm)	1.08 (0.91–1.28)	0.372	1.088 (0.908–1.305)	0.359	1.234 (0.927–1.643)	0.15	1.201 (0.894–1.612)	0.223
Cirrhosis	0.847 (0.56–1.29)	0.435	0.709 (0.410–1.226)	0.218	1.146 (0.526–2.495)	0.731	0.506 (0.176–1.453)	0.205
Portal hypentension	0.98 (0.97–1.43)	0.901	0.913 (0.546–1.527)	0.729	1.506 (0.795–2.853)	0.209	1.469 (0.623–3.468)	0.38
Child-pugh class B VS A	2.65 (1.34–5.26)	0.005	3.129 (1.489–6.579)	0.003	3.671 (1.609–8.376)	0.002	3.121 (1.204–8.093)	0.019
MELD score	1.07 (1.006–1.136)	0.031	1.051 (0.985–1.122)	0.131	1.143 (1.040–1.256)	0.006	1.112 (1.002–1.234)	0.046
Antiviral treatment	1.002 (0.684–1.47)	0.992			1.741 (0.848–3.574)	0.131
Multiple tumor nodules	1.486 (0.949–2.33)	0.083	1.412 (0.876–2.277)	0.157	1.787 (0.927–2.448)	0.083	1.987 (0.981–4.027)	0.057
AFP (>200ng/ml)	1.005 (0.646–1.56)	0.984	1.105 (0.701–1.742)	0.668	1.050 (0.511–2.156)	0.894	0.927 (0.435–1.976)	0.845
ALT (>50 U/L)	0.85 (0.54–1.32)	0.465			0.581 (0.256–1.313)	0.193
AST (>40 U/L)	1.35 (0.92–1.99)	0.123			0.622 (0.331–1.1.67)	0.139

ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; AFP: Alpha fetoprotein; CI: confidence interval; HR: hazard ratio; MELD: model for end-stage liver disease; MWA: microwave ablation; OS: overall survival; PSM: propensity score matching; SR: surgical resection.

Table 4. Factors associated with PFS of the total cohort and the PSM cohort for HCC up to 5 cm.

Variables	Total cohort				PSM cohort
	Univariate analysis		Multivariate analysis		Univariate analysis		Multivariate analysis
	HR (95%CI)	p-value	HR (95%CI)	p-value	HR (95%CI)	p-value	HR (95%CI)	p-value
MWA vs SR	1.103 (0.751–1.365)	0.933	0.928 (0.665–1.294)	0.659	0.950 (0.633–1.424)	0.803	1.129 (0.735–1.733)	0.58
Age (per year)	1.014 (1.001–1.027)	0.029	1.013 (1.000–1.028)	0.058	1.012 (0.993–1.032)	0.225	1.009 (0.987–1.032)	0.407
Gender (male)	0.97 (0.69–1.37)	0.875	1.000 (0.730–1.572)	0.999	1.059 (0.626–1.793)	0.83	0.923 (0.522–1.633)	0.783
Size	1.10 (0.99–1.23)	0.08	1.106 (0.984–1.243)	0.09	1.160 (0.966–1.395)	0.113	1.192 (0.984–1.445)	0.072
Cirrhosis	0.99 (0.75–1.32)	0.963	0.818 (0.567–1.180)	0.283	0.923 (0.58–1.468)	0.735	0.571 (0.309–1.055)	0.073
Portal hypentension	1.10 (0.86–1.41)	0.452	1.094 (0.792–1.511)	0.587	1.088 (0.727–1.628)	0.681	1.087 (0.646–1.830)	0.753
Child-Pugh class B VS A	1.629 (0.91–2.91)	0.1	1.765 (0.953–3.270)	0.071	1.386 (0.67–2.867)	0.379	1.467 (0.665–3.239)	0.343
MELD score	1.035 (0.997–1.075)	0.068	1.031 (0.990–1.074)	0.146	1.077 (1.018–1.140)	0.01	1.071 (1.006–1.139)	0.03
Multiple tumor nodules	1.49 (0.95–2.33)	0.083	1.618 (1.174–2.230)	0.003	1.679 (1.081–2.610)	0.021	1.623 (1.004–2.625)	0.048
Antiviral treatment	1.123 (0.874–1.442)	0.363			1.507 (0.984–2.310)	0.059	1.600 (0.986–2.595)	0.057
AFP (>200ng/ml)	1.01 (0.77–1.32)	0.96	1.084 (0.807–1.457)	0.591	1.095 (0.689–1.740)	0.701	0.935 (0.571–1.532)	0.791
ALT (>50 U/L)	0.84 (0.63–1.13)	0.25			0.803 (0.494–1.305)	0.377
AST (>40 U/L)	1.12 (0.86–1.45)	0.402			1.075 (0.706–1.637)	0.735

ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; AFP: Alpha fetoprotein; CI: confidence interval; HR: hazard ratio; MELD: model for end-stage liver disease; MWA: microwave ablation; PFS: progression-free survival; PSM: propensity score matching; SR: surgical resection.