Combined therapy with microwave ablation and conventional transarterial chemoembolization for hepatocellular carcinoma tumors larger than five centimetres: a prospective study.

[PURPOSE] This study aimed to compare the safety and efficacy of a combined therapy involving microwave ablation (MWA) and transarterial chemoembolization (TACE) versus only TACE for the treatment of hepatocellular carcinoma (HCC) tumors ≥5 cm.

[METHODS] This prospective study enrolled 186 patients with HCC tumors ≥5 cm. Patients were divided into a test group (TACE + MWA) and a control group (TACE only). The average tumor size was 9.2 ± 3.7 cm, ranging from 5 to 19 cm. Forty-five patients (27.4%) had Barcelona Clinic Liver Cancer class A disease, and 119 (72.6%) had class B disease. The viable tumor volume was quantified utilizing ITK-SNAP, a free and open-source software package for medical image segmentation and visualization, along with contrast-enhanced magnetic resonance imaging. The tumor response was assessed according to the modified response evaluation criteria in solid tumors rules. Serum alpha-fetoprotein (AFP) levels were monitored, and the tumor necrosis ratio and AFP variation rate were calculated.

[RESULTS] The final analysis of 164 patients (median age 57 years, range 26-80 years; 19 women, 145 men) showed that the test group exhibited a significantly higher tumor necrosis ratio than the control group (87.5% vs. 76.1%, = 0.002). The serum AFP levels were markedly reduced in the test group relative to the control group 30 days after surgery ( = 0.001). The AFP variation rate in the test group (79.5%) was significantly greater than that observed in the control group (47.5%) ( < 0.001). A significant positive correlation existed between the tumor necrosis ratio and AFP variation rate ( < 0.001). Compared with the control group, the test group demonstrated a significantly higher partial response rate (68.6% vs. 51.3%, < 0.05), a lower rate of progressive disease (17.4% vs. 35.9%, < 0.05), an increased overall response rate (70.9% vs. 55.1%, = 0.036), and an enhanced disease control rate (82.6% vs. 64.1%, = 0.007). Post-MWA, 3 patients experienced hemorrhage and 2 developed arteriovenous fistulae, all of which were treated with embolization.

[CONCLUSION] The combination of TACE and MWA demonstrated safety, good tolerability, and greater efficacy compared with TACE alone for HCC tumors ≥5 cm.

[CLINICAL SIGNIFICANCE] The combination of TACE and MWA offers new possibilities for improving tumor necrosis rates, reducing AFP levels, and enhancing short-term prognosis. These findings not only provide new treatment options for clinical doctors but also promote the application of three-dimensional quantitative assessment technology and provide important references for future research and clinical practice.