Long-term survival analysis of ultrasound-guided percutaneous microwave ablation for hepatocellular carcinoma conforming to the Milan criteria: primary versus recurrent HCC

Figures & data

Figure 1. Flowchart shows patient selection. HCC: hepatocellular carcinoma; IHCC: initial HCC; RHCC: recurrent HCC; MWA: microwave ablation.

Table 1. Baseline characteristics of patients with initial and recurrent hepatocellular carcinoma (HCC) before and after propensity-score matching (PSM).

Variable	Overall population			PSM cohort (1:1)
	Initial HCC (n = 294), %	Recurrence HCC (n = 131), %	p	Initial HCC (n = 124), %	Recurrence HCC (n = 124), %	p
Age ≥60 years	85 (28.9)	56 (42.7)	0.007	49 (39.5)	51 (41.1)	0.897
Male	231 (78.6)	105 (80.2)	0.810	99 (79.8)	100 (80.6)	1.000
Tumor number			0.723			0.693
Single	261 (88.8)	114 (87.0)		111 (89.5)	108 (87.1)
Multiple	33 (11.2)	17 (13.0)		13 (10.5)	16 (12.9)
Extent of tumor, cm			0.710			0.876
Solitary tumor ≤3	233 (79.3)	101 (77.1)		99 (79.8)	97 (78.2)
Others	61 (20.7)	30 (22.9)		25 (20.2)	27 (21.8)
α-fetoprotein, ng/mL			0.585			0.517
≤200	233 (79.3)	100 (76.3)		103 (83.1)	98 (79.0)
>200	100 (20.7)	31(23.7)		21 (16.9)	26 (21.0)
Close to major organs/ vessels			0.641			0.615
Yes	69 (23.5)	24(18.3)		20 (16.1)	23 (18.5)
No	225 (76.5)	107(81.7)		104 (83.9)	101 (81.5)
Aetiology			0.542			0.116
HBV	238 (81.0)	110 (84.0)		93 (75.0)	104(83.9)
Others	56 (19.0)	21 (16.0)		31 (25.0)	20 (16.1)
Liver cirrhosis	255 (86.7)	119 (90.8)	0.298	103 (83.1)	112 (90.3)	0.135
Elevated serum ALT	78 (26.5)	28 (21.4)	0.311	34 (27.4)	27 (21.8)	0.376
Elevated serum AST	95 (32.3)	20 (15.3)	<0.001	23 (18.5)	20 (16.1)	0.737
TBIL >34.1 μmol/L	46 (15.6)	10 (7.6)	0.036	16 (12.9)	10 (8.1)	0.300
Platelet counts <100 × 10^9 /L	182 (61.9)	76 (58.0)	0.515	74 (59.7)	73 (58.9)	1.000
ALBI grade			0.041			0.309
Grade 1	124 (42.2)	70 (53.4)		56 (45.2)	65 (52.4)
Grade 2, 3	170 (57.8)	61 (46.6)		68 (54.8)	59 (47.6)
Ablative margins, cm			0.558			0.316
<0.5	35 (11.5)	19 (14.5)		11 (8.9)	17 (13.7)
≥0.5	259 (88.1)	112 (85.5)		113 (91.1)	107 (86.3)
Follow-up, months	54.0 (48.2, 59.8)	65.0 (53.9, 76.1)	0.008	56.0 (49.3, 62.6)	65.0 (54.1, 75.9)	0.442

Abbreviations: HBV: Hepatitis B virus; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; TBIL: Total Bilirubin level; ALBI: Albumin-Bilirubin.

The bold P values represent the significance between the two groups.

Figure 2. Overall and recurrence-free survival before and after propensity-score matching (PSM). (A,B) The overall survival was significantly better in patients with initial hepatocellular carcinoma (IHCC). (C,D) The recurrence-free survival was significantly better in patients with IHCC. RHCC: recurrent hepatocellular carcinoma.

Figure 3. Forest plot of overall survival in initial and recurrent hepatocellular carcinoma (HCC) patients after microwave ablation with different subgroups. IHCC: initial HCC; RHCC: recurrent HCC; AFP: a-fetoprotein; ALBI: albumin-bilirubin; mOS.mo: median overall survival (months).

Figure 4. Overall survival of patients with initial hepatocellular carcinoma (HCC) and recurrent HCC in these subgroups: (A) solitary HCC ≤3 cm, (B) AFP ≤ 200 ng/ml, (C) ablative margins ≥0.5 cm, (D) ALBI grade 1. AFP: a-fetoprotein; ALBI: albumin-bilirubin; IHCC: initial HCC; RHCC: recurrent HCC.

Figure 5. Forest plot of recurrence-free survival in initial and recurrent hepatocellular carcinoma (HCC) patients after microwave ablation with different subgroups. IHCC: initial HCC; RHCC: recurrent HCC; AFP: a-fetoprotein; ALBI: albumin-bilirubin; mRFS.mo: median recurrent-free survival (months).

Table 2. Uni- And multivariable Cox analysis of factors affecting overall survival after repeat microwave ablation in patients with recurrent hepatocellular carcinoma (HCC).

Variable	Univariable analysis		Multivariable analysis
	HR (95%CI)	p Value	HR (95%CI)	p Value
Sex (man vs. female)	1.38 (0.72–2.64)	0.331
Age (≥60 years vs< 60 years)	0.97 (0.60–1.55)	0.885
Extent of recurrence
Others vs. Solitary HCC ≤3 cm	1.33 (0.75–2.33)	0.333
Time to recurrence, y
≤2 vs. >2	1.15 (0.70–1.88)	0.584
BCLC stage at recurrence		0.347
0	reference
A	1.33 (0.79–2.24)	0.285
B	1.47 (0.65–3.31)	0.359
Close to major organs/vessels (yes vs no)	0.72 (0.38–1.37)	0.311
ALBI grade
2, 3 vs. 1	2.25 (1.39–3.64)	0.001	2.38 (1.46–3.86)	<0.001
Liver cirrhosis	1.29 (0.88–1.86)	0.183
Initial tumor staging
BCLC B vs. A	1.67 (0.83–3.88)	0.152
Aetiology (HBV vs others)	0.91 (0.46–1.79)	0.781
Serum ALT level
Elevated vs. normal	0.76 (0.56–1.04)	0.089
Serum AST level
Elevated vs. normal	0.95 (0.71–1.27)	0.743
Serum TBIL level, μmol/L
>34.1 vs. ≤34.1	1.06 (0.70–1.62)	0.787
Platelet counts, ×10^9/L
<100 vs ≥100	1.25 (0.97–1.61)	0.084
Ablative margins (≥0.5 cm vs <0.5 cm)	0.27 (0.09–0.86)	0.027	0.18 (0.06–0.59)	0.005
Serum AFP level, ng/mL
>200 vs. ≤200	1.34 (1.02–1.76)	0.034	2.07 (1.19–3.62)	0.010

Abbreviations: BCLC: Barcelona Clinic Liver Cancer; ALBI: Albumin-Bilirubin; HBV: Hepatitis B virus; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; TBIL: Total Bilirubin level; AFP: α-fetoprotein.

The bold P values represent the significance between the two groups.

Table 3. Uni- and multivariable Cox analysis of factors affecting recurrence-free survival after repeat microwave ablation in patients with recurrent hepatocellular carcinoma (HCC).

Variable	Univariable analysis		Multivariable analysis
	HR (95%CI)	p value	HR (95%CI)	p VALUE
Sex (man vs. female)	0.82 (0.63–1.06)	0.132
Age (≥60 years vs <60 years)	0.99 (0.80–1.21)	0.895
Extent of recurrence
Others vs. Solitary HCC ≤3 cm	1.44 (0.89–2.29)	0.144
Time to recurrence, y
≤ 2 vs. >2	1.31 (0.85–2.00)	0.216
BCLC stage at recurrence
0	Reference
A	1.05 (0.68–1.64)	0.816
B	1.42 (0.71–2.82)	0.323
Close to major organs/vessels (yes vs no)	1.17 (0.70–1.96)	0.558
ALBI grade
2.3 vs. 1	1.41 (0.93–2.12)	0.104
Initial tumor size
BCLC B vs. A	1.65 (0.87–3.13)	0.121
Aetiology (HBV vs. others)	0.99 (0.56–1.76)	0.979
Serum ALT level
Elevated vs. normal	1.00 (0.79–1.28)	0.965
Serum AST level
Elevated vs normal	1.16 (0.90–1.49)	0.259
Palate counts, ×10^9/L
<100 vs. ≥100	0.93 (0.76–1.14)	0.478
Ablative margins (≥0.5 cm vs. <0.5 cm)	0.44 (0.15–1.30)	0.138
Serum AFP level, ng/mL
>200 vs. ≤200	1.29 (1.02–1.63)	0.036	1.29 (1.02–1.63)	0.036

Abbreviations: BCLC: Barcelona Clinic Liver Cancer; ALBI: Albumin-Bilirubin; HBV: Hepatitis B virus; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase;  AFP: α-fetoprotein.

The bold P values represent the significance between the two groups.