Transarterial Chemoembolization and Sorafenib Combined with Microwave Ablation for Advanced Primary Hepatocellular Carcinoma: A Preliminary Investigation of Safety and Efficacy

Figures & data

Figure 1 Flowchart shows patient selection.

Abbreviations: HCC, hepatocellular carcinoma; TACE, transarterial chemoembolization; MWA, microwave ablation; ECOG, Eastern Cooperative Oncology Group.

Table 1 Baseline Patient Characteristics

Characteristic	MWA Group	Non-MWA Group	P Value
	(n=77)	(n=75)
Age (Year)			0.704
Mean±SD	54.22±12.21	54.92±13.31
Range	22–79	27–78
Gender			0.386
Male	70(90.9)	66(88.0)
Female	7(9.1)	9(12.0)
ECOG (Score)			0.684
0	16(20.8)	10(13.3)
1	39(50.6)	34(45.3)
2	22(28.6)	31(41.4)
Etiology			0.121
HBV/HCV	58(75.3)	60(80.0)
Other	19(24.7)	15(20.0)
Tumor Size (cm)
Mean±SD	5.95±2.05	6.36±2.11	0.234
Range	3.7–10.0	4.1–10.0
No. of Tumors			0.498
Single	33(42.9)	23(30.7)
Multiple	44(57.1)	52(69.3)
PVTT	46(59.8)	49(65.3)	0.194
Main portal vein	0	0	—
First-order PV branch	21(27.3)	27(36.0)	0.247
Second- or lower-order PV branches	25(32.5)	22(29.3)	0.676
AFP Level (ng/mL)
≤ 400	38(49.4)	43(57.3)	0.163
> 400	39(50.6)	32(42.7)
Child–Pugh Class
A	53(68.8)	48(64.0)	0.832
B	24(31.2)	27(36.0)
BCLC Stage C	77(100)	75(100)	—
TACE Sessions
Mean±SD	3.29±1.38	2.88±1.15	0.051
Range	1–8	1–5
Duration of Sorafenib (Month)
Mean±SD	14.19±9.11	11.85±8.21	0.099
Range	3–39	3–28

Note: Unless otherwise indicated, data are the number of patients, with percentage in parentheses.

Abbreviations: SD, standard deviation; ECOG, Eastern Cooperative Oncology Group; HBV, hepatitis B virus; PV, portal vein; PVTT, portal vein tumor thrombosis; AFP, a-fetoprotein; HCV, hepatitis C virus; cm, centimeter; BCLC, Barcelona Clinic Liver Cancer; TACE, transarterial chemoembolization; S, sorafenib; MWA, microwave ablation.

Table 2 Complications and Adverse Events Related to TACE, MWA, and Sorafenib

Complications/AEs	MWA Group (n=77)	Non-MWA Group (n=75)	P Value
Minor Complications	33(42.9)	29(38.7)	0.599
Abdominal pain	15(19.5)	10(13.3)	—
Vomiting	7(9.1)	11(16.0)	—
Nausea	5(6.5)	3(4.0)	—
New ascites	3(3.9)	3(4.0)	—
Pleural effusion	3(3.9)	2(2.7)	—
Major Complications	1(1.29)	1(1.33)	0.985
Liver abscess	0	1(1.33)	—
Hepatic artery hemorrhage	1(1.29)	0	—
CIRSE Grade
1	19(24.7)	16(21.3)	0.625
2	14(18.2)	13(17.3)	0.891
3	1(1.29)	1(1.33)	0.985
4–6	—	—	—
Sorafenib Related AEs
Hypertension	24(31.2)	21(28.0)	0.669
Hand-foot skin reactions	31(40.3)	28(37.3)	0.711
Alopecia	11(14.3)	15(20.0)	0.390
Diarrhea	43(55.8)	48(64.0)	0.305
Gastrointestinal hemorrhage	—	—	—
Fatigue	35(45.5)	30(40.0)	0.415
Dysphonia	5(6.5)	4(5.3)	0.762

Note: Unless otherwise indicated, data are the number of patients, with percentage in parentheses.

Abbreviations: TACE, transarterial chemoembolization; MWA, microwave ablation; AEs, adverse events; CIRSE, Cardiovascular and Interventional Radiological Society of Europe.

Table 3 Summary of Clinical Efficacy in MWA and Non-MWA Groups

	MWA Group	Non-MWA Group	P Value
	(n=77)	(n=75)
Tumor Response
CR	3 (3.9)	0 (0)	0.245
PR	33 (42.8)	9 (12.0)	<0.001
SD	26 (33.8)	20 (26.7)	0.341
ORR (CR+PR)	36 (46.7)	9 (12.0)	<0.001
DCR (CR+PR+SD)	62 (80.5)	29 (38.7)	<0.001
TTP (Month)*	6.0 (5.1–6.9)	3.0 (2.7–3.3)	<0.001
OS (Month)*	19.0 (14.4–77.8)	13.0 (11.6–14.4)	<0.001

Note: *Data are medians, with 95% confidence interval in parentheses.

Abbreviations: MWA, microwave ablation; CR, complete response; PR, partial response; SD, stable disease; ORR, overall response rate; DCR, disease control rate; TTP, time to progression; OS, overall survival.

Figure 2 Kaplan–Meier curves of overall survival in 152 patients with advanced primary hepatocellular carcinoma treated with TACE-S-MWA or TACE-S.

Abbreviations: TACE, transarterial chemoembolization; MWA, microwave ablation; S, sorafenib.

Figure 3 Kaplan–Meier curves of time to progression in 152 patients with advanced primary hepatocellular carcinoma treated with TACE-S-MWA or TACE-S.

Abbreviations: TACE, transarterial chemoembolization; MWA, microwave ablation; S, sorafenib.

Figure 4 Kaplan–Meier curves of overall survival in 152 patients with advanced primary hepatocellular carcinoma with sorafenib duration of no less than 12 months or less than 12 months.

Table 4 Prognostic Factors Associated with Overall Survival and Time to Progression

Factor No. of Patients		Overall Survival			Time To Progression
	(n=152)	Univariate Analysis Multivariate Analysis Univariate Analysis Multivariate Analysis
		P Value	HR (95% CI)	P Value	P Value HR (95% CI) P Value
Age (Year)		0.684			0.100
<65	99
≥65	53
Gender		0.103			0.900
Male	136
Female	16
ECOG (Score)		<0.001	0.71 (0.47–1.09)	0.117	0.007	0.74 (0.52–1.07) 0.112
≤1	99
2	53
Etiology		0.962			0.871
HBV/HCV	118
None	34
No. of Tumors		0.002	0.76 (0.51–1.13)	0.171	0.767
Single	56
Multiple	96
Tumor Size		0.278			0.165
≤5 cm	24
>5 cm	128
PVTT		<0.001	2.08 (1.32–3.28)	0.002	0.837
Without	57
With	95
AFP Level		0.235			0.856
≤400 ng/mL	81
>400 ng/mL	71
Child–Pugh Class		0.007	0.88 (0.57–1.37)	0.582	0.689
A	101
B	51
Duration of Sorafenib		<0.001	2.31 (1.45–3.67)	<0.001	<0.001	1.14 (0.78–1.67) 0.488
<12 months	100
≥12 months	52
TACE Sessions		0.071	0.99 (0.68–1.46)	0.979	0.016	1.08 (0.76–1.53) 0.687
≤3	77
>3	75
MWA Treatment		<0.001	2.03 (1.18–3.50)	0.011	<0.001	3.64 (2.37–5.60) <0.001
Without	75
With	77

Note: Data in parentheses are 95% confidence intervals.

Abbreviations: HR, hazard ratio; CI, confidence interval; ECOG, Eastern Cooperative Oncology Group; HBV, hepatitis B virus; HCV, hepatitis C virus; cm, centimeter; PVTT, portal vein tumor thrombosis; AFP, a-fetoprotein; TACE, transarterial chemoembolization; MWA, microwave ablation.

Figure 5 Kaplan–Meier curves of overall survival in 152 patients with advanced primary hepatocellular carcinoma with or without portal vein tumor thrombosis.

Figure 6 Kaplan–Meier curves of overall survival in 152 patients with advanced primary hepatocellular carcinoma with or without microwave ablation treatment.

Figure 7 Kaplan–Meier curves of time to progression in 152 patients with advanced primary hepatocellular carcinoma with or without microwave ablation treatment.