Synchronous sequential combination of transarterial chemoembolization and microwave ablation for hepatocellular carcinoma: Efficacy and prognosis.

[BACKGROUND] Despite therapeutic advances, outcomes in hepatocellular carcinoma (HCC) remain suboptimal, underscoring the need to explore more effective treatment strategies.

[AIM] To compare efficacy and prognosis in HCC patients treated with synchronous sequential transcatheter arterial chemoembolization (TACE) and microwave ablation (MWA).

[METHODS] A total of 106 patients with HCC admitted between March 2022 and March 2024 were included. Patients receiving concurrent TACE and MWA constituted the synchronous group ( = 56), while those treated with TACE followed by MWA formed the sequential group ( = 50). Intergroup comparisons encompassed curative efficacy, ablation-related parameters (number of needle insertions, ablation duration, and power), prognostic indicators (progression-free survival and overall survival), tumor biomarkers [alpha-fetoprotein (AFP), AFP-L3], hepatic function indices [total bilirubin (TBIL), alanine aminotransferase (ALT), aspartate aminotransferase (AST)], and post-procedural complications (pyrexia, abdominal pain, and gastrointestinal reactions).

[RESULTS] No significant intergroup differences were observed in curative efficacy, ablation power, prognosis, or overall complication rates ( > 0.05). However, the synchronous group required fewer ablation needles and shorter ablation durations than the sequential group ( < 0.05), AFP, AFP-L3, TBIL, ALT, and AST levels significantly decreased after treatment in both groups ( < 0.05), with no significant differences between groups ( > 0.05).

[CONCLUSION] Synchronous TACE combined with MWA is non-inferior to the sequential approach regarding therapeutic efficacy, survival outcomes, safety, and tumor control in HCC. Notably, the synchronous strategy offers procedural advantages by reducing ablation attempts and shortening treatment duration.