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 <0.001). LTP showed no period-dependent advance and > 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.


中文翻译：

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经皮微波消融治疗肝细胞癌的周期依赖性生存获益：12 年真实世界多中心经验

简介：虽然是一种很有前途的肝细胞癌 (HCC) 治疗技术，但微波消融 (MWA) 的 10 年疗效尚不清楚。目的：评估 MWA 治疗 HCC 的进展是否转化为现实世界的生存获益。方法：这项回顾性研究包括来自 5 家医院的 2,354 名巴塞罗那临床肝癌 (BCLC) 0 至 B 期患者，对所有患者进行了至少 2 年的随访。使用具有时间段分层的 Kaplan-Meier 方法分析复发和生存。结果：在 2007-2010、2011-2014 三个时间段内，共有 5,326 例 HCC（平均直径，2.9 cm ± 1.2）接受了 4051 次 MWA，中位随访时间为 61.3（范围 0.6-169.5）个月，和 2015-2018. 技术成功在 5,194 (97. 5%) 肿瘤随着时间的推移显着改善，特别是对于 > 3.0 cm 的 HCC (p <0.001)。LTP 没有显示出与周期相关的进展，并且 > 3.0 cm HCC 和血管周围位置是 LTP 的危险因素。中位肝内转移时间为 27.6 (95% CI 25.2–28.8) 个月，5 年和 10 年发生率分别为 68.8% 和 79.4%。5 年和 10 年总生存率分别为 63.9% 和 41.1%，BCLC 0 期、A、B 期患者的生存率均随时间有明显改善（p<0.001）。中位无病生存时间从 2007-2010 年的 19.4 (95% CI 16.5-22.6) 个月增加到 2015-2018 年的 28.1 (95% CI 25.9-32.3) 个月。经 Cox 回归分析证实，早期复发（≤ 2 年）患者的生存期改善与周期有关。每次手术的主要并发症发生率为 2。2% (88/4051)。结论：这些真实世界的数据显示，在 12 年的随访时间内，MWA 为 BCLC 0-B 期 HCC 患者的生存提供了上升趋势。也令人鼓舞地观察到早期复发患者的明显生存获益。