Clinical Efficacy Analysis Of TACE Combined With Fan Stacked MWA For Large Primary Liver Cancer

Objective:To observe the feasibility,safety,local control rate and survival rate of transcatheter arterial chemoembolization(TACE)combined with fan stacked microwave ablation(MWA)for the treatment of primary large liver cancer.Methods:We retrospectively studied patients with primary large liver cancer treated at our hospital from January 2018 to May 2022,including 25 patients treated with TACE alone and 30 patients treated with TACE combined with fan stacked MWA.The efficacy evaluation was carried out according to response evaluation criteria in solid tumor 1.1(RECIST 1.1)and modified response evaluation criteria in solid tumor(m RECIST)criteria and the differences in the evaluation results were observed,and the efficacy evaluation results were classified as complete(CR),partial response(PR),stable disease(SD)or progressive disease(PD),and the tumor necrosis rate(TNR)after treatment was calculated using 3D software and imaging technology.Calculate the objective response rate(ORR)and disease control rate(DCR)of patients,their progression-free survival(PFS),overall survival(OS),cause of progression,subsequent treatment after progression,and treatment-related adverse events(TRAEs)were counted.Logistic risk models were used to perform univariate and multifactorial regression analyses of ORR to identify the characteristic factors with which they were associated.The Kaplan-Meier method was used to plot PFS and OS curves,and the COX proportional risk regression model was used to perform univariate and multifactorial analyses of PFS and OS,respectively.Results:1.Recent efficacy: ORR was 3.3% versus 12.0%(P=0.477)and DCR was86.7% versus 76.0%(P=0.503)in the two groups evaluated according to RECIST 1.1criteria,respectively,and the differences were not statistically significant.However,the ORR was 90.0% versus 56.0%(P=0.010)and the DCR was 90.0% versus 80.0%(P=0.507)for the two groups,respectively,evaluated according to the m RECIST criteria,and there was a significant difference in ORR between the two groups.In addition,hepatitis B virus infection status and combined microwave ablation were significantly associated with ORR.2.Long-term outcome: median PFS was 20.1 months versus 6.9 months in the combined treatment group versus the treatment-only group,respectively(P<0.001),and median OS was 37.2 months versus 25.4 months in the two groups,respectively(P=0.019).The number of intrahepatic tumors and combined microwave ablation treatment were independent prognostic factors affecting patients’ PS,and age and combined microwave ablation were independent factors affecting patients’ OS prognostic factors.3.Adverse reactions: The patients in both groups tolerated well,and adverse reactions were common in grade I/II.The incidence of elevated aspartate transaminase(AST)and elevated total bilirubin(TBIL)was higher in the simple treatment group than in the combined treatment group(P<0.05),and the incidence in grade I/II of the remaining adverse reactions in the two groups was not significantly different(P>0.05).Logistic regression analysis of univariate and multifactor revealed that elevated TBIL was significantly associated with ORR.4.Reasons for progression and subsequent treatment: The risk of subsequent enlargement of the primary tumor or local recurrence was higher in the treatment-only group compared with the combination treatment group(P=0.013).The probability of local treatment after progression was higher in the monotherapy group compared with the combination treatment group(P=0.004).Conclusion:1.When evaluating the tumor efficacy of patients with primary large liver cancer after local treatment,there are differences in the evaluation results using RECIST 1.1and m RECIST criteria.RECIST 1.1 criteria may have errors,and m RECIST is more recommended for evaluating tumor remission.2.TACE combined with fan stacked MWA improves immediate and long-term patient outcomes,reduces the risk of primary site enlargement or local recurrence,reduces the probability of subsequent local treatment,and has a high safety profile.3.The near-term efficacy of TACE combined with fan stacked microwave ablation for primary large liver cancer patients was associated with hepatitis B virus infection,microwave ablation treatment,and elevated TBIL as an adverse effect;the long-term efficacy was associated with age,number of intrahepatic tumors,and microwave ablation treatment.