Therapeutic Effect Of TACE Combined With MWA In The Treatment Of Patients With Hepatocellular Carcinoma Who Meet UCSF Criteria

Objective: To explore the value of TACE combined with microwave ablation in patients with hepatocellular carcinoma who meet the UCSF criteria for liver transplantation based on propensity score matching method,and to compare the difference in treatment effect,overall survival rate and progression-free survival rate between surgical resection and treatment.To provide a theoretical basis for the application of microwave ablation combined with TACE in the treatment of hepatocellular carcinoma.Methods: Retrospective analysis of 274 patients who met the UCSF criteria for liver transplantation from May 2008 to January 2014 in the Hospital were divided into TACE+MWA group(n=129)and surgery group(n=145)according to different treatment methods.using the propensity score matching method to process the data,so that the multiple characteristic variables of the two groups of subjects were generally balanced,and the clinical data,treatment effects and the overall survival of the two groups of patients before and after the matching were analyzed and compared.Rate and progression-free survival.Results: Gender,age,tumor size and number,HBs Ag positive rate,compliance with Milan criteria,total bilirubin(TBIL),alanine aminotransferase(ALT),aspartate aminotransferase(AST)There was no significant difference(P>0.05),but there was significant difference in liver function(Child-Pugh)score,preoperative alpha-fetoprotein(AFP)level and platelet count(PLT)(P<0.05).A total of 128 patients were enrolled in the study after propensity score matching,including 64 in the TACE+MWA group and the surgery group.All 64 patients in the TACE+MWA group underwent TACE before ablation.The success rate of TACE was 100%,of which 49 patients received 1 TACE,13 patients received 2 TACE,and 2 patients received 3 Secondary TACE treatment.After 1 week to 4 weeks of TACE treatment,MWA treatment was performed.64 patients had 104 tumor lesions,101 lesions achieved complete ablation,and the complete ablation rate was 97.1%.The complete ablation rate of ?3cm lesions was 100%,The complete ablation rate of 3~5cm lesion was 96%,and the complete ablation rate of greater than 5 cm lesion was 78.8%.In the surgical group,the pathological reports of 102 lesions after 102 resection showed R0 resection,and the complete resection rate was 100%.Complications showed 1 case of liver abscess in TACE+MWA group,1 case of ascites,and serious complication rate was 3.1%.In surgical group,2 cases had ascites and 1 case had severe bleeding.The incidence of serious complications was 4.7.%(P=0.648).In terms of liver function,one day after treatment,the ALT of the TACE+MWA group was 179.3±72.6 and the AST was 158.4±68.7.The ALT of the surgical group was 226.1±89.2 and the AST was 213.8±76.5.There was a significant difference between the two groups(P< 0.05).In terms of long-term survival rate,before matching,the overall survival rates of 129 patients in the TACE+MWA group at 1 year,3 years,and 5 years were 98.5%,80.6%,and 55.8%,respectively.In the surgical group,145 patients were 1 year,3 years,The 5-year overall survival rate was 96.5%,85.5%,and 71.7%,respectively(P=0.006);the progression-free survival rates of TACE+MWA group at 1 year,3 years,and 5 years were 82.9%,35.7%,and 15.5%,respectively;The progression-free survival rates in the surgical group at 1 year,3 years,and 5 years were 84.8%,53.8%,and 37.9%,respectively(P < 0.000).After matching,The overall survival rates of 64 patients in the TACE+MWA group at 1 year,3 years,and 5 years were 98.5%,85.9%,and 68.9%,respectively.The overall survival rates of 64 patients in the surgical group at 1 year,3 years,and 5 years were respectively.95.3%,84.4%,and 73.4%(P=0.603);the progression-free survival rates of 1 year,3 years,and 5 years in the TACE+MWA group were 82.8%,32.8%,and 15.6%,respectively;The progression-free survival rates in the surgical group at 1 year,3 years,and 5 years were 76.6%,51.6%,and 29.7%,respectively(P=0.047).Subgroup analysis was performed according to the size of the tumor.Among them,TACE+MWA group had 30 cases of tumor lesions ?3cm,and 34 cases of more than 3cm.In the surgical group,29 cases had lesions with a maximum diameter of ?3cm and 35 cases with a diameter of more than 3cm.When the maximum diameter of the tumor was ?3cm,the 1-,3-,and 5-year overall survival rates of the TACE+MWA group were 100%,90%,and 73.3%,respectively.The 1-,3-,and 5-year overall survival rates of the surgical group were 96.5.%,86.2%,79.3%(P=0.640);The progression-free survival rates in the TACE+MWA group at 1 year,3 years,and 5 years were 86.7%,50%,and 26.7%,respectively.The progression-free survival rates in the surgical group at 1 year,3 years,and 5 years were 79.3%,58.6%,and 41.4%,respectively(P = 0.292).When the maximum diameter of the tumor was greater than 3cm,the 1-,3-,and 5-year overall survival rates of the TACE+MWA group were 97.1%,82.3%,and 64.7%,respectively.The 1-,3-,and 5-year overall survival rates of the surgical group were 94.3.%,82.9%,68.6%(P=0.735);and progression-free survival rates in the TACE+MWA group at 1 year,3 years,and 5 years were 79.4%,17.6%,and 5.9%,respectively.The progression-free survival rates in the surgical group at 1 year,3 years,and 5 years were 74.3%,45.7%,and 20%,respectively(P=0.022).Conclusion: TACE combined with MWA treatment of hepatocellular carcinoma patients who meet the UCSF criteria for liver transplantation has a satisfactory therapeutic effect and safety,and can obtain long-term survival time comparable to surgical resection,and has good clinical application value.However,surgical resection has better progression-free survival than TACE combined with MWA.