Long-term efficacy and safety of microwave ablation for hepatocellular carcinoma adjacent to the gallbladder with a diameter ≤ 5 cm: a multicenter, propensity score matching study

Figures & data

Figure 1. Study flowchart. MWA: microwave ablation; BCLC: Barcelona Clinic Liver Cancer; PSM: propensity score matching.

Table 1. Baseline characteristics of patients before and after PSM.

	Before PSM			After PSM
Characteristics	Adjacent (n = 49)	Nonadjacent (n = 608)	p value	Adjacent (n = 48)	Nonadjacent (n = 48)	p value
Sex(male/female)	38/11	490/118	0.606	37/11	39/9	0.615
Age(year), Mean ± SD	59.06 ± 11.97	57.10 ± 11.28	0.244	58.65 ± 11.74	62.21 ± 12.63	0.156
Child-pugh (A/B)	49/0	598/10	1.000	47/0	46/1	1.000
Median aCCI [P25,P75]	2(1,3)	2(1,3)	0.232	2(1,3)	2(1,4)	0.151
Etiology(HBV/HCV/NBNC)	35/4/10	424/52/132	1.000	34/4/10	35/5/8	0.893
Cirrhosis, n(%)	41(83.7)	491(80.8)	0.617	40(83.3)	40(83.3)	1.000
Tumor number (1/2/3)	39/9/1	443/120/45	0.335	38/9/1	35/9/4	0.482
Tumor size(cm), Mean ± SD	2.68 ± 0.85	2.53 ± 1.00	0.311	2.64 ± 0.80	2.88 ± 0.17	0.052
Median AFP(P25,P75), ug/L	6.4(3.0,23.5)	10.8(3.9,64.5)	0.031	6.4(3.1,25.3)	8.1(3.4,49.0)	0.577
Median ALT(P25,P75), U/L	25.3(18.7,33.1)	28.8(21.4,41.0)	0.093	25.3(19.8,33.2)	28.8(21.5,40.6)	0.479
Median AST(P25,P75), U/L	28.0(21.3,39.0)	26.5(21.7,38.2)	0.712	28.0(22.7,39.5)	26.5(21.5,43.2)	0.775
Median GGT(P25,P75), U/L	42.4(27.5,75.4)	41.7(29.0,69.3)	0.666	42.4(27.3,72.7)	41.6(29.7,55.4)	0.339
Median TBIL (P25,P75), μmol/L	12.6(9.3,19.8)	14.4(10.9,19.3)	0.334	13.0(9.4,19.9)	15.1(11.3,20.1)	0.305
Median DBIL (P25,P75), μmol/L	4.5(3.4,6.9)	4.9(3.6,7.0)	0.544	4.5(3.3,6.9)	5.1(4.2,6.8)	0.292
Median ALB (P25,P75), g/L	40.1(38.9,41.6)	39.8(37.8,42.5)	0.876	40.1(38.9,41.2)	39.8(36.8,42.0)	0.615
Median GLU (P25,P75), μmol/L	4.8(4.6,5.6)	5.0(4.7,5.8)	0.121	4.8(4.6,5.5)	5.2(4.6,6.1)	0.074
Median Hb (P25,P75), g/L	136(125,141)	139(129,149)	0.006	135(126,141)	139(130,146)	0.143
Median RBC (P25,P75), 10^9/L	4.3(4.1,4.5)	4.4(4.0,4.8)	0.011	4.3(4.1,4.5)	4.4(4.0,4.8)	0.276
Median PLT (P25,P75), 10^9/L	116(81,128)	119(83,156)	0.025	103(80,129)	117(89,143)	0.215
Median PT (P25,P75), s	14.1(13.2,15.1)	13.9(13.2,14.8)	0.566	14.1(13.2,15.1)	13.8(12.8,14.4)	0.089

PSM: propensity score matching; aCCI: age-adjusted Charlson comorbidity index; HBV: hepatitis B virus; HCV: hepatitis C virus; AFP: alpha-fetoprotein; ALT: alanine aminotransferase; AST: aspartate aminotransferase; GGT: gamma-glutamyl transferase; TBIL: total bilirubin; DBIL: direct bilirubin; ALB: albumin; GLU: blood glucose; Hb: hemoglobin; RBC: red blood cell; PLT: platelet; PT: prothrombin time; P₂₅: 25th percentile; P₇₅: 75th percentile.

Figure 2. Kaplan–meier curves of the adjacent gallbladder cohort and nonadjacent gallbladder cohort before and after PSM. (A) PFS before PSM; (B) PFS after PSM; (C) OS before PSM; (D) OS after PSM. PSM: propensity score matching; PFS: progression-free survival; OS: overall survival.

Table 2. Univariate and multivariate analyses of PFS after PSM.

	Univariate analysis		Multivariate analysis
Characteristics	HR (95% CI)	p value	HR (95% CI)	p value
Sex (male)	1.320(0.759,2.295)	0.326
Age (≥65 year)	0.810(0.508,1.291)	0.375
aCCI (>3)	1.169(0.688, 1.987)	0.563
Etiology (HBV)	1.108(0.663,1.851)	0.695
Etiology (HCV)	0.794(0.345,1.832)	0.589
Cirrhosis (yes)	1.158(0.623,2.151)	0.643
Tumor number (>1)	1.112(0.687, 1.798)	0.666
Tumor size (>3.0 cm)	0.983(0.550,1.756)	0.953
Adjacent to gallbladder(yes)	1.011(0.647,1.578)	0.963
AFP (>200μmg/L)	1.827(0.960,3.476)	0.066
ALT (>40U/L)	1.608(0.961,2.690)	0.070
AST (>40U/L)	1.727(1.054,2.831)	0.030	1.727(1.054,2.831)	0.030
GGT (>50 U/L)	1.407(0.881,2.247)	0.153
TBIL (>21μmol/L)	1.026(0.598,1.759)	0.926
DBIL (>8.6 μmol/L)	1.488(0.763,2.751)	0.258
ALB (>35 g/L)	0.604(0.317,1.151)	0.126
GLU (>6.1 mmol/L)	1.562(0.907,2.690)	0.107
Hb (<120 g/L)	1.178(0.659,2.104)	0.580
RBC (<4.3 × 10^9/L)	1.099(0.698,1.731)	0.682
PLT (<100 × 10^9/L)	1.604(1.012,2.542)	0.044
PT (<13s)	0.904(0.548,1.491)	0.692
First technical success	1.211(0.739,1.984)	0.448
Completely ablation (no)	1.613(0.647,4.020)	0.305
Temperature monitoring (yes)	0.867(0.520,1.446)	0.585
Ethanol injection (yes)	1.240(0.765,2.009)	0.382
Hydrodissection (yes)	1.255(0.542,2.906)	0.595
CEUS (yes)	0.956(0.579,1.581)	0.862

DFS: disease-free survival; PSM: propensity score matching; HR: hazard ratio; CI: confidence interval; aCCI: age-adjusted Charlson comorbidity index; BCLC: Barcelona Clinic Liver Cancer; HBV: hepatitis B virus; HCV: hepatitis C virus; AFP: alpha-fetoprotein; ALT: alanine aminotransferase; AST: aspartate aminotransferase; GGT: gamma-glutamyl transferase; TBIL: total bilirubin; DBIL: direct bilirubin; ALB: albumin; GLU: blood glucose; Hb: hemoglobin; RBC: red blood cell; PLT: platelet; PT: prothrombin time; CEUS: contrast-enhanced ultrasound.

Table 3. Univariate and multivariate analyses of OS after PSM.

	Univariate analysis		Multivariate analysis
Characteristics	HR (95% CI)	p value	HR (95% CI)	p value
Sex (male)	1.165(0.580,3.342)	0.668
Age (≥65 year)	1.906(1.062,3.420)	0.031	1.977(1.095,3.570)	0.024
aCCI (>3)	2.341(1.254, 4.370)	0.008
Etiology (HBV)	0.527(0.288,0.962)	0.037
Etiology (HCV)	1.348(0.527,3.450)	0.533
Cirrhosis (yes)	0.570(0.281,1.157)	0.120
Tumor number (>1)	1.599(0.892, 2.865)	0.115
Tumor size (>3.0 cm)	1.037(0.499,2.155)	0.922
Adjacent to gallbladder(yes)	0.925(0.522,1.639)	0.789
AFP (>200μmg/L)	0.961(0.406,2.275)	0.928
ALT (>40U/L)	1.565(0.797,3.076)	0.194
AST (>40U/L)	2.374(1.298,4.340)	0.005
GGT (>50 U/L)	2.015(1.120,3.626)	0.019	1.930(1.063,3.504)	0.031
TBIL (>21μmol/L)	1.273(0.627,2.584)	0.504
DBIL (>8.6 μmol/L)	2.409(1.146,5.061)	0.020
ALB (>35 g/L)	0.242(0.116,0.504)	0.000	0.258(0.123,0.543)	0.000
GLU (>6.1 mmol/L)	2.086(1.070,4.064)	0.031
Hb (<120 g/L)	1.802(0.932,3.485)	0.080
RBC (<4.3 × 10^9/L)	1.862(1.051,3.298)	0.033
PLT (<100 × 10^9/L)	2.078(1.172,3.684)	0.012
PT (<13s)	0.716(0.332,1.544)	0.394
First technical success	1.166(0.614,2.216)	0.639
Completely ablation (no)	22.404(0.103,4876.800)	0.258
Local tumor progression (yes)	1.090(0.429,2.769)	0.856
Intrahepatic metastasis (yes)	0.904(0.456,1.790)	0.771
Extrahepatic metastasis (yes)	1.544(0.845,2.822)	0.158
Temperature monitoring (yes)	1.219(0.665,2.237)	0.522
Ethanol injection (yes)	0.820(0.619,2.691)	0.192
Hydrodissection (yes)	1.090(0.336,3.540)	0.885
CEUS (yes)	1.334(0.727,2.446)	0.352

OS: overall survival; PSM: propensity score matching; HR: hazard ratio; CI: confidence interval; aCCI: age-adjusted Charlson comorbidity index; BCLC: Barcelona Clinic Liver Cancer; HBV: hepatitis B virus; HCV: hepatitis C virus; AFP: alpha-fetoprotein; ALT: alanine aminotransferase; AST: aspartate aminotransferase; GGT: gamma-glutamyl transferase; TBIL: total bilirubin; DBIL: direct bilirubin; ALB: albumin; GLU: blood glucose; Hb: hemoglobin; RBC: red blood cell; PLT: platelet; PT: prothrombin time; CEUS: contrast-enhanced ultrasound.

Figure 3. Kaplan–meier curves of HCC patients with tumor <3 cm (A, C) and 3-5 cm (B, D) after PSM. (A)PFS of HCC patients with tumor <3cm; (B)PFS of HCC patients with tumor 3-5 cm; (C) OS of HCC patients with tumor <3 cm; (D) OS of HCC patients with tumor 3-5 cm. HCC: hepatocellular carcinoma; PSM: propensity score matching; PFS: progression-free survival; OS: overall survival.

Table 4. Perioperative treatment status of patients in the adjacent and nonadjacent groups after PSM.

Variables	Adjacent (n = 48)	Nonadjacent (n = 48)	p value
Assistive technologies, n (%)	35(72.9)	15(31.3)	0.000
Temperature monitoring, n (%)	22(46.8)	3(6.3)	0.000
Ethanol injection, n (%)	23(47.9)	4(8.3)	0.000
Hydrodissection, n (%)	7(14.6)	1(2.1)	0.059
Contrast-enhanced ultrasound, n (%)	16(33.3)	13(27.1)	0.505
Technique success rate, n (%)	43(89.6)	45(97.9)	0.204
Local tumor progression, n (%)	5(10.4)	4(8.3)	1.000
Complications, n (%)	29(60.4)	29(60.4)	1.000
Immediate complications	29(60.4)	29(60.4)	1.000
Abdominal pain, n (%)	13(27.1)	11(22.9)	0.637
NRS pain score, Median (P25,P75)	0(0,1)	0(0,0)	0.549
Days of abdominal pain, Median (P25,P75)	0(0,1)	0(0,0)	0.937
Fever, n (%)	23(47.9)	26(54.2)	0.540
Maximum temperature, Median (P25,P75)	37.2(36.5,38.4)	37.6(36.4,38.2)	0.909
Days of fever, Median (P25,P75)	0(0,3)	1(0,2)	0.789
Delayed complications	2(4.2)	0(0)	0.495
Abscess, n (%)	1(2.1)	0	1.000
Needle tract implantation metastases, n (%)	1(2.1)	0	1.000
Operative time, Median Seconds (P25,P75)	600(398,915)	600(360,960)	0.965
Hospital stay, Median Days (P25,P75)	6(4,8)	6(5,8)	0.581

PSM: propensity score matching; NRS: numeric rating scale; P₂₅: 25th percentile; P₇₅: 75th percentile.

Data availability statement

We understand the terms of the share upon reasonable request data policy, and our data generated or analyzed during the study are available from the corresponding author by request.