The Multivariate Analysis Of Long Term Outcomes Of Microwave Ablation For Hepatocellular Carcinoma

Objective:With the development of thermal ablation,ultrasound-guided microwave ablation(MWA)is considered as a safe and effective treatment strategy of liver cancer.However,tumors near a special area are usually considered difficult to be treated completely with imaging guiding.Therefore,special precautions and strategies are required to treat tumors in these dangerous locations.This study aims at evaluating the safety and efficacy of ultrasound-guided(US-guided)percutaneous microwave(MW)ablation to treat HCC tumor adjacent to dangerous locations by analyzing the efficacy of microwave ablation on hepatocellular carcinoma(HCC)in our hospital in recent years.Materials and Methods:From July 2011 to September 2013,375 patients with 491 HCCs were treated by MWA.292 male and 83 female patients were included(age range,27–82 years;mean age,58.7 years).The average largest diameter of HCC was(2.25±0.8)cm(range,0.6–4.9cm).257 of the 375 HCC patients had cirrhosis with a Child-Pugh classification A,18,class B.The follow-up period was defined as the time period from MW ablation to the time of death,or the final clinical visit before 30 September 2013.The average interval between initial surgery and the diagnosis of recurrence was 32 months(range,1—60 months).The distance between the edge of the tumor to the gallbladder was measured as the shortest distance on an axial image or on an axial image from CT or MRI images reconstructed at 5-mm intervals and on US.The patients were divided into two groups according to the tumor location: group I(high-risk areas,196 patients,258 tumors);group II(low-risk areas,179 patients,233 tumors).In group I,12 cases had tumors close to the hilum,89,adjacent to the capsule and 106,against the diaphragm.All patients underwent contrast-enhanced CT or MRI examination within one month after MW ablation and then were reexamined every 3-to 6-month intervals.If the patients were not suitable for contrast agent CT or MRI,a contrast-enhanced US was performed.All statistical analyses were performed using a software package(SPSS21.0 for Windows).A difference with P<0.05 was considered significant.Results:A complete ablation rate of 97.8%(480/491)was achieved.The incidence of complications was 1.2% and there was no treatment-related death.The 1-,3-and 5-year post-ablation disease-free survival rates were 72.8%,39.8%,24.2%,respectively.Complete ablation was achieved in group I and group II were 96.67%?97.85%.The 1-,3-and 5-year disease-free survival rates in group I and group II were were 68.88%,36.22%,25.37% and 73.74%,43.17%,19.12%,respectively.The 1-,3-and 5-year cumulative survival rates in group I and group II were 90.87%,69.50%,60.05% and 94.97%,74.24%,64.91%,respectively.All the patients were followed to July 2016.After treatment,8 patients had major conmplications,among whom,one was diaphragmatic hernia and his physical condition was improved after treatment,3 massive pleural effusion,1 massive ascites,2 abscess and 1 bleeding.Univariate analysis showed that the largest diameter of tumor,platelet,PT,bilirubin and albumin were significant risk factors affecting recurrence-freel survival.The largest diameter of tumor and platelet were significant risk factors affecting overall survival.Conclusions:In a conclusion,ultrasound-guided percutaneous microwave ablation is a safe and effective treatment option for hepatocellular carcinoma.