Abstract

Objective

To compare the long-term outcomes of MWA as the first-line treatment for HCC in peribiliary versus non-peribiliary locations using propensity score matching analysis.

Methods

The study participants were recruited between April 2012 and October 2016. In total, 236 patients with HCC <5 cm who underwent ultrasonography-guided percutaneous MWA as the first-line treatment were enrolled. The patients were grouped into two according to tumor location: peribiliary (n = 74) and non-peribiliary (n = 162). The progression-free survival (PFS) and overall survival (OS) rates were compared before and after propensity score matching. Subgroup analyses were conducted for the peribiliary group according to the biliary grading.

Results

Propensity score matching yielded 63 matched pairs of patients. In the two matched groups, cumulative PFS rates were 29.0% and 14.0% in the peribiliary group, and 51.0% and 31.0% in the non-peribiliary group at 3 and 5 years, respectively. Corresponding OS rates were 51.0% and 49.0% in the peribiliary group, and 77.0% and 70.0% in the non-peribiliary group at 3 and 5 years, respectively. In addition, there were significant differences in major complication rates between the two groups (25.7% vs 8.0%; p < .001). In contrast to peribiliary HCCs adjacent to the second-degree branches of intrahepatic bile duct (67.1 ± 5.2 months), subgroup analysis indicated that the mean OS was significantly lower in peribiliary HCCs adjacent to the first-degree branches (51.2 ± 7.5 months) (p = .015).

Conclusion

The application of MWA for peribiliary HCC leads to a higher rate of complications and worse long-term tumor control than for non-peribiliary HCC.

• KEY POINTS

• The application of MWA for peribiliary HCC leads to a higher rate of complications than for non-peribiliary HCC.

• The application of MWA for peribiliary HCC leads to worse long-term tumor control than for non-peribiliary HCC. Abbreviations: Hepatocellular carcinoma (HCC); microwave ablation (MWA); α-fetoprotein (α-FP); local tumor progression (LTP); intrahepatic distal recurrence (IDR); progression-free survival (PFS); overall survival (OS).

中文翻译：

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微波消融治疗胆汁性肝细胞癌：长期预后的倾向评分分析

摘要

客观的

为了比较使用倾向评分匹配分析将MWA作为胆管癌和非胆管癌HCC的一线治疗的长期结果。

方法

在2012年4月至2016年10月之间招募了研究参与者。总共招募了236例HCC <5 cm的患者，他们接受了超声引导下的经皮MWA作为一线治疗。根据肿瘤位置将患者分为两部分：胆管癌（n  = 74）和非胆管癌（n  = 162）。比较倾向评分匹配前后的无进展生存率（PFS）和总生存率（OS）。根据胆道分级对胆道组进行亚组分析。

结果

倾向得分匹配产生了63对匹配的患者。在两个匹配组中，在3年和5年时，胆管癌组的PFS累积率分别为29.0％和14.0％，非胆管癌组的PFS率为51.0％和31.0％。分别在3年和5年时，胆管癌组的OS发生率分别为51.0％和49.0％，非胆管癌组的OS发生率分别为77.0％和70.0％。此外，两组的主要并发症发生率也有显着差异（25.7％vs 8.0％；p  <.001）。与邻近肝内胆管第二级分支的胆汁性肝癌（67.1±5.2个月）相比，亚组分析表明，邻近第一级分支的胆汁性肝癌的平均OS显着降低（51.2±7.5个月）（p  = .015）。

结论

与非胆道癌相比，MWA在胆道癌中的应用导致并发症发生率更高，长期肿瘤控制更差。

• 关键点

• MWA在胆道癌中的应用比非胆道癌的并发症发生率更高。

• 与非胆汁性肝癌相比，MWA在胆汁性肝癌中的应用导致长期肿瘤控制更差。缩写：肝细胞癌（HCC）；微波消融（MWA）；α-甲胎蛋白（α-FP）; 局部肿瘤进展（LTP）; 肝内远端复发（IDR）；无进展生存期（PFS）；整体生存率（OS）。