Comparative Study Of Application Of Computed Tomography/ultrasound And Computed Tomography Imaging Guidance Methods In The Microwave Ablation Of Liver Cancer

Objective: To analyze the efficacy of computed tomography(CT)combined with ultrasound(US)guidance in microwave ablation(MWA)for the treatment of early-stage hepatocellular carcinoma(HCC),and to provide a reference basis for the selection of imaging guidance modalities in the clinical treatment of early-stage hepatocellular carcinoma.Methods: The clinical data of 150 patients with early-stage hepatocellular carcinoma admitted to our oncology department between July 2016 and June 2021 were collected.The CT/US and CT groups were divided according to the imaging guidance modality in ablation.The gender,Barcelona stage(BCLC stage),number of tumors,number of tumors at high-risk sites,tumor size,ablation session,number of intraoperative CT scans,procedure time,total complete ablation rate,complete ablation rate of tumors at high-risk sites,incidence of total complications,incidence of different kinds of complications,recurrence rate after complete ablation and progression-free survival were compared and analyzed in the two groups.The Kaplan-Meier survival curve method was used to analyze the progression-free survival(PFS)of both groups,logistic regression analysis was used to predict the risk factors for the occurrence of incomplete ablation and the complications of different imaging-guided modalities,and Cox regression analysis was used to predict the risk factors for progression after ablation.Results:1.There were statistical differences in the ablation session,number of CT scan times,procedure time,total complete ablation rate,complete ablation rate of tumors at high-risk location,incidence of pneumothorax,incidence of nausea and vomiting,and incidence of abdominal pain between the two groups(p<0.05).while there were no statistical differences in gender,BCLC stage,number of tumors,tumor size,incidence of total complications,recurrence rate after complete ablation,incidence of hypothermia,incidence of pleural,and incidence of pleural effusion was not statistically different between the two groups(p>0.05).2.The median PFS was 18 months(95% confidence interval [CI],12.72-23.27)with CT/US group and 13 months(95%,3.90-22.08)with the CT group.The 1-and 3-year progression-free survival rates in CT/US group were 94.5% and 73.8%,respectively,and 81.0% and 50.2%,respectively for the CT group,and CT/US group has a better short-term PFS(Log-rank p=0.103;Breslow p=0.030).The imaging guidance modality(OR,0.303;95% CI,0.095–0.970;P=0.044)was an independent factor for complete ablation.3.Logistic regression model results Patients with CT-guided MWA were more likely to experience nausea and vomiting after ablation(OR,0.221;95% CI,0.083-0.593;P = 0.003).CT/US guidance modality is the risk factor for the incident of abdominal pain after ablation(OR,2.502;95% CI,1.160–5.397;P = 0.019).In multivariate analysis,guidance modality(HR,0.586;95% CI,0.368–0.934;P=0.025)and BCLC stage(HR,2.933;95% CI,1.678–5.127;P<0.001)were risk factor for PFS.Conclusion: Compared with CT-guided microwave ablation therapy alone,CT/US-guided microwave ablation therapy for early-stage hepatocellular carcinoma can improve the efficacy and safety.