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. 2022 Jul;76(1):66-77.
doi: 10.1002/hep.32323. Epub 2022 Jan 28.

Microwave ablation versus laparoscopic resection as first-line therapy for solitary 3-5-cm HCC

Zhen Wang  1   2 , Miao Liu  3 , De-Zhi Zhang  4 , Song-Song Wu  5 , Zhi-Xian Hong  6 , Guang-Bin He  7 , Hong Yang  8 , Bang-de Xiang  9 , Xiao Li  10 , Tian-An Jiang  11 , Kai Li  12 , Zhe Tang  13 , Fei Huang  14 , Man Lu  15 , Ji-An Chen  14 , Yu-Cheng Lin  5 , Xiao Lu  7 , Yu-Quan Wu  8 , Xiao-Wu Zhang  10 , Ye-Fan Zhang  16 , Chao Cheng  11 , Huo-Lin Ye  12 , Lan-Tian Wang  17 , Hua-Ge Zhong  2 , Jian-Hong Zhong  9 , Lu Wang  15 , Miao Chen  18 , Fang-Fang Liang  19 , Yi Chen  2 , Yan-Song Xu  20 , Xiao-Ling Yu  1 , Zhi-Gang Cheng  1 , Fang-Yi Liu  1 , Zhi-Yu Han  1 , Wei-Zhong Tang  2 , Jie Yu  1 , Ping Liang  1
Affiliations

Microwave ablation versus laparoscopic resection as first-line therapy for solitary 3-5-cm HCC

Zhen Wang et al. Hepatology. 2022 Jul.

Abstract

Background and aims: The study objective was to compare the effectiveness of microwave ablation (MWA) and laparoscopic liver resection (LLR) on solitary 3-5-cm HCC over time.

Approach and results: From 2008 to 2019, 1289 patients from 12 hospitals were enrolled in this retrospective study. Diagnosis of all lesions were based on histopathology. Propensity score matching was used to balance all baseline variables between the two groups in 2008-2019 (n = 335 in each group) and 2014-2019 (n = 257 in each group) cohorts, respectively. For cohort 2008-2019, during a median follow-up of 35.8 months, there were no differences in overall survival (OS) between MWA and LLR (HR: 0.88, 95% CI 0.65-1.19, p = 0.420), and MWA was inferior to LLR regarding disease-free survival (DFS) (HR 1.36, 95% CI 1.05-1.75, p = 0.017). For cohort 2014-2019, there was comparable OS (HR 0.85, 95% CI 0.56-1.30, p = 0.460) and approached statistical significance for DFS (HR 1.33, 95% CI 0.98-1.82, p = 0.071) between MWA and LLR. Subgroup analyses showed comparable OS in 3.1-4.0-cm HCCs (HR 0.88, 95% CI 0.53-1.47, p = 0.630) and 4.1-5.0-cm HCCs (HR 0.77, 95% CI 0.37-1.60, p = 0.483) between two modalities. For both cohorts, MWA shared comparable major complications (both p > 0.05), shorter hospitalization, and lower cost to LLR (all p < 0.001).

Conclusions: MWA might be a first-line alternative to LLR for solitary 3-5-cm HCC in selected patients with technical advances, especially for patients unsuitable for LLR.

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