| Objective:To study the safety and efficacy of high-powered microwave ablation versus radiofrequency ablation in treating larger hepatocellular carcinoma and to clarify the risk factors of recurrence after percutaneous microwave coagulation (PMCT) and radiofrequency ablation.Methods:A total of101Patients with hepatitis B virus (HBV) associated HCC, who had not received any treatment before percutaneous microwave coagulation therapy (PMCT) and radiofrequency ablation, were enrolled in this study.45Patients with60lesions received microwave ablation by using high Power80-100W through percutaneous approach.56Patients with68lesions received radiofrequency ablation. The Procedure was carried out for a total all lesions with the diameter of3-8cm. Thirteen possible risk factors and three possible prognosis factors of primary liver cancer postoperative recurrene and metastasis were statistieally analyzed. The factors included sex, age, tumor number, tumor maximum diameter, liver function Child-pugh grades, BCLC stage, pre-operation AFP level, post-operation AFP level, HBeAg type, HBV-DNA, and so on. The local tumor control, distant recurrence, complications and the follow-up index for short-term therapeutic efficacy evaluation were recorded. The factors related to HCC recurrence were analysis by using univariate analysis and multivariate analysis method.Result:The contrast enhanced ultrasound and the contrast enhanced CT or MRI was performed one month after ablation. The MWA group complete ablation rate was82.61%(38/46) for the first ablation and100%(46/46) for the second ablation, compared with RFA group80.0%(40/50),98%(49/50) for the lesion with3-5cm. The WMA group complete ablation rate was64.29%(9/14) for the first ablation and85.71%(12/14) for the second ablation, compared with RFA group33.33%(5/18),50%(9/18) for the lesion with≥5cm. MWA group the lesion were successfully punctured by a single manipulation and the ablation procedure took6minutes. After the microwave ablation, there are a total of10patients after18lesions local recurrence within2years,3-5cm tumor size which has14,≥5cm which has4. Eighteen of45patients (40%) developed recurrence and (or) metastasis after ablation. RFA group ablation procedure took12minutes. After the ablation, there are a total of16patients after26lesions local recurrence within2years,3-5cm tumor size which has14,≥5cm which has12.24of56patients (40%) developed recurrence and (or) metastasis after ablation. The one-year and two-year survival rate was95.56%(43/45) and86.67(39/45). The one-year and two-year survival rate was94.64%(53/56) and89.29%(50/56).Univariate analysis showed that a positive correlation existed between the lesions number (P=0.025), proximity to a major bile duct (P=0.001), pre-ablation a-foetoprotein (AFP)(P=0.031), HBV-DNA (P=0.035), and early recurrence. Multivariate analysis identified HBV-DNA (P=0.023) and proximity to a major bile duct (P=0.001) as the independent prognosis factor causing postoperative HCC recurrence.Conclusion:1. High-powered percutaneous microwave ablation versus radiofrequency ablation of larger hepatocellular carcinoma appeared to have higher complete ablation rate, especially for tumor diameter≥5cm (P=0.035)2. Local recurrence rate of High-power microwave ablation in the treatment of large hepatocellular carcinoma (diameter≥5cm) was lower than radiofrequency ablation.3. Two groups of patients in the treatments did not occur major bleeding, liver rupture, liver abscesses, severe complications and surgery-related deaths intestinal perforation. It is indicated that both high-powered percutaneous microwave ablation and radiofrequency ablation for larger hepatocellular carcinoma are safe and effective.4. The lesions number, proximity to a major bile duct, pre-ablation a-foetoprotein (AFP), HBV-DNA are important risk factors causing postoperative HCC recurrence.5. HBV-DNA (P=0.023) and proximity to a major bile duct (P=0.001) as the independent prognosis factors causing postoperative HCC recurrence. |
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