Comparison of the Efficacy and Safety of Transarterial Chemoembolization Plus Microwave Ablation versus Surgical Resection in Patients with Solitary Large Hepatocellular Carcinoma: A Propensity Score-Matched Analysis

Figures & data

Figure 1 Flow chart of patient selection criteria.

Table 1 The Detailed Characteristics of the Patients Before and After PSM

Characteristic	Before PSM (N=148)		P	After PSM (N=86)		P
	TACE+MWA N=94	Liver Resection N=54		TACE+MWA N=43	Liver Resection N=43
Age	61.1±9.56	53.8±10.3	<0.001	56.9±8.71	57.2±7.34	0.831
Sex			0.734			0.406
Male	73 (77.7%)	44 (81.5%)		37 (86.0%)	33 (76.7%)
Female	21 (22.3%)	10 (18.5%)		6 (14.0%)	10 (23.3%)
Etiology			0.920			1.000
HBV	77 (81.9%)	43 (79.6%)		34 (79.1%)	34 (79.1%)
HCV	2 (2.13%)	1 (1.85%)		1 (2.33%)	1 (2.33%)
Other	15 (16.0%)	10 (18.5%)		8 (18.6%)	8 (18.6%)
Tumor size, cm	6.47±1.26	6.33±1.53	0.569	6.27±1.20	6.38±1.53	0.808
Pre-TACE			1.000			1.000
No	83 (88.3%)	48 (88.9%)		39 (90.7%)	39 (90.7%)
Yes	11 (11.7%)	6 (11.1%)		4 (9.30%)	4 (9.30%)
Cirrhosis			1.000			1.000
No	34 (36.2%)	19 (35.2%)		14 (32.6%)	14 (32.6%)
Yes	60 (63.8%)	35 (64.8%)		29 (67.4%)	29 (67.4%)
Antiviral therapy			0.454			0.369
No	20 (21.3%)	8 (14.8%)		30 (69.8%)	25 (58.1%)
Yes	74 (78.7%)	46 (85.2%)		13 (30.2%)	18 (41.9%)
AFP:			0.833			0.736
< 400 ng/mL	57 (60.6%)	31 (57.4%)		4 (9.52%)	6 (14.3%)
≥ 400 ng/mL	37 (39.4%)	23 (42.6%)		38 (90.5%)	36 (85.7%)
ALT (IU/L):	31.8 [24.5–46.1]	27.2 [19.4–34.6]	0.041	28.0 [22.2–43.0]	26.9 [21.2–34.8]	0.671
AST (IU/L):	35.0 [25.3–52.7]	28.5 [21.9–39.6]	0.018	30.1 [25.0–47.3]	27.5 [23.2–34.5]	0.254
TBIL (mg/dL)	12.2 [8.48–19.1]	11.9 [8.83–15.3]	0.541	11.4 [8.10–19.1]	11.4 [8.83–14.6]	0.651
Album (g/L)	39.7±4.58	40.0±4.14	0.668	40.1±4.83	40.0±4.01	0.860
Child-Pugh			0.5			1.000
A	84 (89.4%)	50 (92.6%)		41 (95.4%)	41 (95.4%)
B	10 (10.6%)	4 (7.4%)		2 (4.6%)	2 (4.6%)
ALBI grade			0.154			1.000
I	50 (53.2%)	36 (66.7%)		26 (60.5%)	27 (62.8%)
II or III	44 (46.8%)	18 (33.3%)		17 (39.5%)	16 (37.2%)
Neutrophil (10^9/L)	4.06±7.81	3.33±1.18	0.374	3.03±1.20	3.36±1.17	0.201
Lymphcyte (10^9/L)	1.64±1.99	1.47±0.58	0.439	1.60±1.88	1.49 ±0.60	0.721
PLT(10^9 /L)	153±75.0	147±57.5	0.643	145±77.7	149±60.2	0.822
INR	1.04 ±0.07	1.04±0.15	0.940	1.08±0.09	1.05±0.16	0.654

Note: Data are exhibited in N (%) or median (interquartile range).

Abbreviations: TACE, transcatheter arterial chemoembolization; MWA, microwave ablation; HBV, hepatitis B virus; HCV, hepatitis C virus; ALBI, albumin-bilirubin; AFP, alpha-fetoprotein; NLR, neutrophil to lymphocyte.

Figure 2 Overall survival (OS) of patients before or after propensity score matching. (A) There is no significant difference in terms of OS in the TACE-MWA group and liver resection group. (P = 0.93). (B) In the propensity score-matched cohort, TACE-MWA showed comparable efficacy to liver resection (P = 0.3).

Figure 3 Subgroup analysis between patients with tumor size <7cm and ≥7cm. There was no significant difference in the OS in patients with HCC patients with tumor size <7cm. P = 0.6) between the two groups. In patients with HCC ≥7cm, the OS of patients in the TACE-MWA group showed better efficacy in the liver resection group (P = 0.041).

Table 2 Univariate and Multivariate Analyses of Prognostic Factors for Overall Survival in Patients with Solitary Large HCC and in the Propensity Score-Matched Cohort

Variable	Univariate	P	Multivariate	P
	HR (95% CI)		HR (95% CI)
Sex:
Female vs Male	0.91 (0.47–1.75)	0.773
Age:
≥ 60 vs < 60	1.04 (0.59–1.83)	0.884
Treatment:
Liver Resection vs TACE-MWA	1.30 (0.79–2.16)	0.304
Pre-TACE:
Yes vs No	0.81 (0.32–2.02)	0.648
ALBI Grade:
II or III vs I	1.25 (0.75–2.09)	0.384
Cirrhosis:
Yes vs No	1.06 (0.60–1.86)	0.845
Antiviral treatment
Yes vs No	0.25 (0.13–0.52)	0.002	0.57 (0.34–0.97)	0.037
Tumor Size
≥7cm vs <7cm	2.27 (1.30–3.95)	0.004	1.88 (1.07–3.31)	0.029
AST (IU/L):
≥40 vs <40	0.86 (0.47–1.56)	0.614
ALT (IU/L):
≥40 vs <40	0.67 (0.36–1.25)	0.211
AFP (ng/mL):
≥400 vs <400	0.92 (0.54–1.56)	0.752
TBIL (mg/dL):
≥17.1 vs <17.1	1.19 (0.67–2.11)	0.558
ALB (g/L):
≥35 vs <35	0.83 (0.50–1.38)	0.473
NLR:
≥2.81 vs <2.81	3.34 (1.97–5.68)	<0.001	3.49 (1.79–6.83)	<0.001

Abbreviations: TACE, transcatheter arterial chemoembolization; MWA, microwave ablation; HBV, hepatitis B virus; HCV, hepatitis C virus; ALBI, albumin-bilirubin; AFP, alpha-fetoprotein; NLR, neutrophil to lymphocyte.

Figure 4 Progression-free survival (PFS) of patients before or after propensity score matching. (A) There is no significant difference in terms of PFS in the TACE-MWA group and liver resection group. (P = 0.12). (B) In the propensity score-matched cohort, TACE-MWA showed comparable PFS to liver resection (P = 0.66).

Table 3 Univariate and Multivariate Analyses of Prognostic Factors for Progression Free Survival in Patients with Solitary Large HCC and in the Propensity Score-Matched Cohort

Variable	Univariate	P	Multivariate	P
	HR (95% CI)		HR (95% CI)
Sex:
Female vs Male	0.86 (0.47–1.58)	0.629
Age:
≥ 60 vs < 60	1.23 (0.73–2.07)	0.427
Treatment:
Liver Resection vs TACE-MWA	0.95 (0.60–1.52)	0.829
Pre-TACE:
Yes vs No	1.14 (0.52–2.49)	0.747
ALBI Grade:
II or III vs I	0.97 (0.61–1.55)	0.893
Cirrhosis:
Yes vs No	1.53 (0.92–2.55)	0.101
Antiviral treatment
Yes vs No	0.55 (0.43–0.71)	0.001	0.47 (0.34–0.65)	<0.001
Tumor Size
≥7cm vs <7cm	2.15 (1.31–3.54)	0.003	2.04 (1.24–3.37)	0.005
AST (IU/L):
≥40 vs <40	1.05 (0.62–1.77)	0.861
ALT (IU/L):
≥40 vs <40	0.90 (0.53–1.54)	0.701
AFP (ng/mL):
≥400 vs <400	1.27 (0.79–2.04)	0.333
TBIL (mg/dL):
≥17.1 vs <17.1	1.11 (0.65–1.90)	0.700
ALB (g/L):
≥35 vs <35	1.09 (0.69–1.73)	0.719
NLR:
≥2.81 vs <2.81	2.07 (1.28–3.35)	0.003	1.97 (1.22–3.20)	0.006

Abbreviations: TACE, transcatheter arterial chemoembolization; MWA, microwave ablation; HBV, hepatitis B virus; HCV, hepatitis C virus; ALBI, albumin-bilirubin; AFP, alpha-fetoprotein.

Table 4 Safety in Patients with Solitary Large HCC Before and After PSM

Characteristic	Before PSM (N=148)		P	After PSM (N=86)		P
	TACE+MWA N=94	Liver Resection N=54		TACE+MWA N=43	Liver Resection N=43
Major complications	15 (27.8%)	6 (6.32%)	0.001	10 (23.3%)	2 (4.65%)	0.029
Liver failure	2 (3.70%)	0 (0.00%)	0.132	2 (4.60%)	0 (0.00%)	0.494
Biliary leakage	1 (1.85%)	2 (2.13%)	1.000	0 (0.00%)	1 (2.33%)	1.000
Ascites	2 (3.70%)	0 (0.00%)	0.132	0 (0.00%)	0 (0.00%)	1.000
Liver abscess	2 (3.70%)	2 (2.13%)	0.623	1 (2.33%)	0 (0.00%)	1.000
Hemorrhage	3 (5.56%)	2 (2.13%)	0.355	2 (4.65%)	1 (2.33%)	1.000
Pulmonary infection	5 (9.26%)	0 (0.00%)	0.006	2 (4.65%)	0 (0.00%)	0.006
Abdominal infection	2 (3.70%)	0 (0.00%)	0.132	2 (4.65%)	0 (0.00%)	0.132