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Comparison of Microwave Ablation and Transarterial Chemoembolization for Single-Nodule Hepatocellular Carcinoma Smaller Than 5cm: A Propensity Score Matching Analysis

Authors Cui R, Wang X, Ma C, Liu T, Cheng Z, Han Z, Liu F, Yu X, Yu J, Liang P

Received 26 April 2019

Accepted for publication 27 October 2019

Published 23 December 2019 Volume 2019:11 Pages 10695—10704


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 4

Editor who approved publication: Dr Sanjeev Srivastava

Rui Cui,1,2 Xiao-hui Wang,3 Chao Ma,4 Tong Liu,5 Zhi-gang Cheng,1 Zhi-yu Han,1 Fang-yi Liu,1 Xiao-ling Yu,1 Jie Yu,1,* Ping Liang1,*

1Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing 100853, People’s Republic of China; 2Department of Ultrasonography, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510000, People’s Republic of China; 3Department of Ultrasonography, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, People’s Republic of China; 4Department of Ultrasonography, Qiqihaer Hospital of Chinese Medicine, Qiqihaer 161000, People’s Republic of China; 5Department of Ultrasonography, Hebei Chest Hospital, Shijiazhuang 050000, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Ping Liang; Jie Yu
Department of Interventional Ultrasound, Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, People’s Republic of China
Tel +86-10-66939530
Fax +86-10-68161218

Purpose: To compare overall survival (OS) and progression-free survival (PFS) between microwave ablation (MWA) and transarterial chemoembolization (TACE) for solitary hepatocellular carcinoma (HCC) smaller than 5 cm.
Methods: Patients with solitary HCC smaller than 5cm who initially underwent MWA or TACE were identified in Chinese PLA General Hospital from June 2010 to October 2015. Propensity score matching (PSM) was performed with a 1:1 matching protocol. OS and PFS were compared by using the log-rank test. After matching, subgroup analysis based on tumor size (≤3cm/3.1–5cm) was also conducted. Prognostic factors for OS and PFS were assessed with Cox proportional hazard regression model.
Results: A total of 202 patients (MWA, n=120; TACE, n=82) were identified. After matching, 116 patients were included (58 patients for each treatment group). MWA provided significantly better OS and PFS than TACE for both the entire cohort (OS, P<0.001; PFS, P<0.001) and the matched cohort (OS, P=0.015; PFS, P<0.001). Subgroup analysis showed that among patients with tumor of 3cm or less, the MWA group had significantly better OS (P=0.027) and PFS (P=0.008) than the TACE group. Multivariate Cox regression analysis showed TACE was associated with worse OS (hazard ratio, 2.385; 95% CI: 1.427, 3.985; P=0.001) and PFS (hazard ratio, 2.567; 95% CI: 1.820, 3.622; P<0.001).
Conclusion: MWA outperformed TACE for solitary HCC smaller than 5cm in OS and PFS. For single tumors less than 5cm, especially those smaller ones (≤3cm), priority should be given to MWA when making treatment options between MWA and TACE.

Keywords: hepatocellular carcinoma, transarterial chemoembolization, microwave ablation, overall survival, progression-free survival

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