Clinical Results, Risk Factors, and Future Directions of Ultrasound-Guided Percutaneous Microwave Ablation for Hepatocellular Carcinoma

Figures & data

Table 1 Complete Ablation, Disease-Free Survival, Overall Survival, Local Recurrence, Complications, and Mortality in Patients with HCC Treated with MWA

Study	Size	No.	CA	DFS Rates	OS Rates	Local Recurrence	Complications	Mortality
Swan RZ-2013^Citation30	0.5–8.5 cm	54	94.1%	1,2-year: 58%,36%	1,2-year: 72%,59%	2.9%	11.5%	0 (30d)
Sun AX-2015^Citation31	3.0–5.0 cm	182	93%	1,2-year: 51%,27%	1,2-year: 89%,60%	15.9%	2.7%	0.5% (30d)
Zhang TT-2015^Citation32	≤5 cm	89	91.0%	1,3,5,7-year: 59%,26%,22%,11%	1,3,5,7-year: 73%,54%,40%,17%	-	-	-
Baker EH-2016^Citation33	1–6cm	219	97.1%	-	1,2-year: 80%,62%	8.5%	3.2%	1.8%
Yin T-2017^Citation34	0.9–6.2cm	220	92.8%	1-year: 81%	1-year: 95%	-	-	-
Ma S-2017^Citation35	≤10 cm	433	98.6%	1-year: 31.3%	1,2,3-year: 84%,66%,59%	12.9%	5.3%	0

Note: –, Not applicable.

Abbreviations: CA, complete ablation; DFS, Disease-free survival; OS, Overall survival.

Table 2 Disease-Free Survival, Overall Survival, Local Recurrence, Complication Rates, and Mortality in Patients with HCC Treated with Microwave Ablation (vs. SR and LR)

Study	Size	Treatment	DFS Rates	OS Rates	Local Recurrence	Complications	Mortality
			1,3,5-year	1,3,5-year
Wang ZL-2008^Citation42	<5 cm	SR (n=80)	69%,60%,26%	-	0%	72.5%	-
		MWA (n=114)	73%,54%,33%	-	13.2%	68.4%	-
Takami Y-2013^Citation43	≤3 cm	SR (n=34)	97%,59%,37%	97%,81%,67%	1,3,5-year: 1.9%,4.8%,5.9%	-	-
		MWA (n=390)	90%,56.%,40%	98%,85%,70%	1,3,5-year: 0%, 4.3%,4.3%	7.0%	-
Shi J et al 2014^Citation48	Milan criteria	SR (n=107)	85%,57%,31%	94%,72%,60%	10.2%		-
		MWA (n=117)	77%,38%,18%	94%,70%,52%	2.8%		-
Li W-2017^Citation44	≤3 cm	SR (n=87)	96%,66%,62%	94%,81%,72%	3.4%	73.5%	0%
		LR (n=133)	93%,62%,52%	99%, 834%,77%	3.7%	42.8%	0%
		MWA (n=60)	72%,38%,35%	100%, 75%, 67%	25.0%	21.6%	0%
Zhang QB-2017^Citation45	Milan criteria	SR (n=42)	No significant differences	95%,71%,38%	2.1%	52.3%	2.4%
		MWA (n=31)		97%,53%,43%	7.4%	13.7%	0%
Chong CCN-2017^Citation46		SR (n=63)	756%,66%,58%	95%,83%,80%	0.5%	40.7%	0%
		MWA (n=63)	63%,31%,18%	98%,72%,61%	14.3%	7.4%	0%
Ryu T et al 2019^Citation39	≤ 5 cm	SR (n=94)	90%,65%,55%	100%,89%,76%,	2.1%	-	-
		MWA (n=94)	92%,62%,47%	99%,85%,77%	7.4%	-	-
Zheng H-2020^Citation47	3–5cm	SR (n=80)	74%,42%,36%	97%,89%,71%	1.3%	78.8%	0.7%
		MWA (n=80)	64%,37%,33%	90%,80%,66%	6.3%	55%	1.1%
Wang Z-2022^Citation24	3–5cm	LR (n=335)	86%,69%,57%	96%,81%,66%	Recurrence:30%	4.8%	29.2%
		MWA (n=335)	82%,56%,47%	96.%,83%,71%	Recurrence:32%	3.3%	22.6%
	3–5cm	LR (n=257)	86%,69%,56%	96%,82%,66%	Recurrence:34%	5.4%	21.4%
		MWA (n=257)	85%,57%,50%	98%,85%,67%	Recurrence:38%	2.7%	14.3%

Note: –, Not applicable.

Abbreviations: SR, Surgical resection; LR, Laparoscopic resection; DFS, Disease-free survival; OS, Overall survival.

Table 3 Disease-Free Survival, Overall Survival, Local Recurrence, Complication Rates, and Mortality in Patients with HCC Treated with Microwave Ablation (vs. RFA)

Study	HCC	Treatment (NO.)	CA	DFS Rates	OS Rates	Local Recurrence	Complications	Mortality
				1,3,5-year	1,3,5-year
Xu HX-2004^Citation51	0.9–8.8 cm	RFA (n=78)	89.7%	47%,31%,-	76%,50%,-	7.1%	9.3%	1.0%
		MWA (n=112)	94.6%			12.8%
Lu MD-2005^Citation52	≤ 8 cm	RFA (n=53)	93.1%	37%,16%,-	72%,378%,-	20.9%	5.7%	0%
		MWA (n=49)	94.9%	46%,27%,-	82%,51%,-	11.8%	8.2%	0%
Shibata T-2006^Citation53	≤ 3 cm	RFA (n=38)	93%	44%,22%,-	94%,77%,-	1,3-year: 17%,22%	2.1%
		MWA (n=36)	95%	47%,34%,-	100%,94%,-	1,3-year: 12%,20%	0%
Ohmoto K-2009^Citation54	≤ 2 cm	RFA (n=34)	-	-	100%,70%,-	1,3-year: 9%,9%	12%	-
		MWA (n=49)	-	-	89%,49%,-	1,3-year: 13%,19%	35%	-
Yin XY-2009^Citation60	3–7cm	RFA (n=59)	89.8%	-	76%,47%,31%	26.4%	9.2%	0%
		MWA (n=49)	95.9%	-		17.0%		0%
Simo KA-2011^Citation55	≤ 5 cm	Lap-RFA (n=22)	88.8%	-	-	7.7%	61.5%	13.6%
		Lap-MWA (n=13)	92.3%	-	-	0%	44.4%	0%
Ding J et al 2013^Citation56	Milan criteria	RFA (n=85)	99.0%	80%,39%,-	99%,83%-	5.2%	2.4%	0%
		MWA (n=113)	98.5%	75%,32%,-	98%,78%,-	10.9%	2.7%	0%
Zhang L-2013^Citation61	≤ 5 cm	RFA (n=78)	83.4%	71%,42%,34%	91%,64%,41%	11.8%	2.6%	0%
		MWA (n=77)	86.7%	62.%,34%,21%	92%,52%,39%	10.5%	2.6%	0%
	1–3cm	RFA (n=47)	-	68%,34%,27%	94%,66%,43%	-	-	0%
		MWA (n=36)	-	72%,42%,25%	100%,81%,57%	-	-	0%
	3–5cm	RFA (n=31)	-	74%,55%,45%	87%,61%,40%	-	-	0%
		MWA (n=41)	-	53%,27%,17%	85%,37%,22%	-	-	0%
Zhang XG et al 2014^Citation57	0.8–11.4cm	RFA (n=173)	86.7%	-	92%,-,-	-	-	-
		MWA (n=349)	83.7%	-	90%,-,-	-	-	-
Abdelaziz A-2014^Citation58	≤ 5 cm	RFA (n=45)	94.2%	-	68%,-,-	13.5%	11.1%	-
		MWA (n=66)	96.1%	-	96%,-,-	3.9%	3.2%	-
Vogl TJ-2015^Citation59	Milan criteria	RFA (n=25)	84.4%	97%,91%,-	100%,72%,-	15.6%	48%	-
		MWA (n=28)	88.9%	97%,92%,-	100%,79%,-	11.1%	53.6%	-
Potretzke TA-2016^Citation37	≤ 5 cm	RFA (n=55)		Patients treated with RFA have lower survival rates		17.7%	3.6%	0%
		MWA (n=99)				8.8%	1.0%	0%

Note: –, Not applicable.

Abbreviations: RFA, Radiofrequency ablation; DFS, Disease-free survival; OS, Overall survival.

Table 4 The Factors of Influencing Tumor Progression

TP	Tumor Factors	Background Factors
LTP	Tumor size (>3 cm) Tumor number (≥2) Tumor location (adjacent to the major vessel) All ablated margin (<3mm)	AFP level (>100 ng/mL) Pre-ablation AFP levels HBV -DNA replication
IDR	Tumor size Tumor number	A low platelet count (<100,000/microL) The presence of ascites High levels of AFP Age-platelet index (API) Cirrhosis CTP grade B
AIR	Location abutting major vessels Periportal tumor location	Older age CTP grade B Younger patient age
EDR	Tumor size Tumor necrosis Macrovascular invasion Range of surgical margin Venous and/or lymphatic involvemen	Serum albumin <4 g/dL Serum alkaline phosphatase > 100 U/L Ablation zone/tumor size < 2 AFP level > 400 IU/mL

Abbreviations: TP, Tumor progression; LTP, Local tumor progression; IDR, Intrahepatic distant recurrence; AIR, Aggressive intrasegmental recurrence; EDR, Extrahepatic distant recurrence.

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