| Objective1. Using prospectively multi-center study to evaluate the clinic therapeutic effectiveness and prognostic risk factors of ultrasound (US)-guided cooled-probe microwave ablation (MWA) for early-stage primary liver cancer.2. To investigate the clinic outcomes of percutaneous cooled-probe MWA of primar liver cancer in difficult locations and to compare the results with safe location primary liver cancer.Methods1. From February 2012 to Novermber 2015,1492 patients with 2573 liver cancer nodules were treated with US-guided percutaneous MWA in 9 hospitals in China. The mean diameters of tumors were 2.96 ± 0.54cm (range:0.9cm-5.0cm). The patients before operation were assessed with unified standards. After ablation, the technique effectiveness rate (TER), local tumor progression (LTP) rate, intrahepatic distant metastasis rate, recurrence-free survival (RFS) rate and overall survival (OS) rate were observed. Eleven possible tumour-related and treatment-related factorsforLTP, intrahepatic distant metastasis RFS and OS were evaluated by univariate and multivariate analysis.2. To compared 783 patients with 1350 lesions (diameter,0.9-5 cm; mean,2.91 ± 0.52 cm)into dangerous group (tumors< 5 mm from the vital tissues, such as bile duct,gastrointestinal tract, gallbladder, blood vessels) with 709 patients with 1223 lesions (diameter,1.0-5.0 cm; mean,2.95±0.59 cm) insafe group (more than5 mm away from vessels, gallbladder, gastrointestinal tract, diaphragm and hepatic surface) in 9 hospitals in China.During the ablation, the lesions were monitored and controlled. If necessary, ancillary techniques (such as artificial pleural effusion/ascites, thermal monitoring systemand ethonal ablation) were used meanwhile. After ablation, the TER, LTP rate and OS rate of different groups were evaluated.Results1. During the multiinstitutional study, the mean follow-up time was 25.4 months (range:1.79-52.01 months).97.9%(2521/2573) tumors in adjacent to dangerous group achieved complete ablation, no variable showed a significant impact on incompleteablation in adjusted, multivariable logistic regression. Major complications were occueered in 41 patients (41/1492,2.27%). LTP were diagnosed in 117 lesions (4.5%). The LTP rate at 1,2,3 years were 9.8%,13.7%,15.6% respectively. Intrahepatic distant metastasis were diagnosed in 792 lesions (30.8%). Intrahepatic distant metastasis rate at at 1,2,3 years were 33.4%,52.9%,74.8% respectively.9.0% (135/1492) of the patients were diagnosed with extrahepatic distant metastasis.227 (15.5%) patients died during the follow-up time. RFS rate and OS rate at 1,2, and 3 years were 62.2%,37.2%,22.8% respectively and 96.6%,88.7%,79.3%, respectively. The multivariate analysis showed that, tumor size was the only independent risk factor associated with LTP; tumor number and AFP were the independent risk factors associated with intrahepatic distant metastasis; tumor number was the independent risk factors associated with RFS; age, tumor size, tumor number, AFP, tumour differentiation and extrahepatic distant metastasis were the independent risk factors associated with OS.2. Adjacent to dangerous group were segmented into adjacent to gastrointerstina tract, adjacent to gallbladder, adjacent to large blood vessels, adjacent diaphragm and adjacent hepatic surface.113 patients with 2291esions were enrolled in adjacent to gastrointerstina tract (mean diameter,2.87± 0.61cm); 94 patients with 164 lesions were eenrolled in adjacent to gallbladder (mean diameter,2.85±0.73cm); 221 patients with 363 lesions were enrolled in adjacent to lager blood vessels (mena diameter, 2.89±0.57cm); 174 patients with 300 lesions were enrolled in adjacent to diaphragm (mean diameter,2.94±0.61cm); 171 patients with 294 lesions were enrolled in adjacent to hepatic surface (mean diameter,2.88±0.84cm). During the multiinstitutional study, the mean follow-up time was 25.4 months (range 1.79-52.01 months). TER in the dangerous group was similar to that in the control group (97.1%vs 98.9%, P=0.080). The complication rate in thedifficult group was significantly higher than that in thecontrol group (4.9%vs 0.8%, P=0.041). LTP rate in the dangerous group and the safe group at 1,2,3 years were 9.6%,12.3%,15.9% respectively and 6.9%,11.9%,14.1% respectively. There was no significant statistical difference between the two group (P=0.063). The 1-,2-,3-year OS rates in the dangerous groupwere not significantly different from those in the safe group (95.7%, 87.4%,78.6% vs 97.4%,89.9%,79.6% respectively, P=0.236).Additionally, a multivariate analysis revealed that tumorlocation was not a significant risk factor for survival (P=0.135).Conclusions1.US-guided percutaneous cooled-probe microwave ablation for early-stage primary liver cancer has good medium-termclinic curative effect2. US-guided percutaneous MWA combined with ancillary techniquesis an efficient and safetechnology in treating primary liver cancer adjacent to dangerous location. |
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