Period-dependent survival benefit of percutaneous microwave ablation for hepatocellular carcinoma: 12-year real-world multicentric experience

Abstract

Introduction: Although being a promising technique for hepatocellular carcinoma (HCC) treatment, the 10-year efficacies of microwave ablation (MWA) are unknown. Objective: To assess whether the advances of MWA for HCC translated into a real-world survival benefit. Methods: This retrospective study included 2,354 patients with Barcelona Clinic Liver Cancer (BCLC) stage 0 to B from 5 hospitals, with at least 2 years of follow-up for all the patients. Recurrence and survival were analyzed using the Kaplan-Meier method with time-period stratification. Results: A total of 5,326 HCCs (mean diameter, 2.9 cm ± 1.2) underwent 4051 sessions of MWA with a median follow-up of 61.3 (ranging 0.6–169.5) months during three time-periods of 2007–2010, 2011–2014, and 2015–2018.Technical success was achieved in 5,194 (97.5%) tumors with significant improvement over time, especially for > 3.0 cm HCC (p 3.0 cm HCC and perivascular location were the risk factors for LTP. The median intra-hepatic metastasis time was 27.6 (95% CI 25.2–28.8) months, with 5- and 10-year occurence rate of 68.8% and 79.4%, respectively. The 5- and 10-year overall survival were 63.9% and 41.1%, respectively, and BCLC stage 0, A, B patients all with an observable survival improvement over time(p<0.001). The median disease-free survival time increased from 19.4 (95% CI 16.5–22.6) months in 2007–2010 to 28.1 (95% CI 25.9–32.3) months in 2015–2018. The improved survival for early recurrent (≤ 2 years)patients was period- dependent as verified by Cox regression analyses. The major complications rate per procedure was 2.2% (88/4051). Conclusions: These real-world data show MWA provided anupward trend in survivalfor HCC patients with BCLC stage 0–B over a 12-year follow-up time. A clear survival benefit in early recurrent patients was also observed encouragingly.