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Volume 40 Issue 9
Sep.  2024
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Article Navigation >  Journal of Clinical Hepatology  > 2024  >  40(9): 1807-1815

Efficacy and safety of microwave ablation versus hepatic resection in treatment of hepatocellular carcinoma with liver cirrhosis： A Meta-analysis

DOI: 10.12449/JCH240915
  • 1.

    Department of Infectious Diseases，The Affiliated Hospital of Chengdu University of Traditional Chinese Medicine，Chengdu 610072，China

  • 2.

    School of Clinical Medicine，Chengdu University of Traditional Chinese Medicine，Chengdu 610072，China

  • 3.

    Department of Traditional Chinese Medicine，Caojiaxiang Community Health Service Center，Chengdu 610081，China

Research funding:

Science and Technology Foundation Project of Hospital of Chengdu University of Traditional Chinese Medicine (21YY03)

More Information
  • Corresponding author: HU Xiaoyu， xiaoyuhu@aliyun.com （ORCID： 0000-0003-0187-4386）
  • Received Date: 2024-02-18
  • Accepted Date: 2024-04-01
  • Published Date: 2024-09-25
    Abstract
  •   Objective  To investigate the efficacy and safety of microwave ablation （MWA） versus hepatic resection （HR） in the treatment of hepatocellular carcinoma （HCC） with liver cirrhosis using a meta-analysis.  Methods  This study was conducted according to the PRISMA guideline， with a PROSPERO registration number of CRD42024509185. PubMed， the Cochrane Library， EMBASE， Web of Science， CNKI， VIP， and Wanfang Data were searched for randomized controlled trials （RCTs） and cohort studies on MWA versus HR in the treatment of HCC with liver cirrhosis published up to November 2023， and Stata 12.0 was used to perform the meta-analysis.  Results  A total of 3 RCTs and 5 retrospective cohort studies were included， with 953 patients in total. The meta-analysis showed that there were no differences between MWA and HR in 1-， 2-， 3-， and 5-year overall survival （OS） rates （all P>0.05） and 1-， 2-， and 5-year recurrence rates （all P>0.05）. Compared with HR， MWA had a significantly higher 3-year recurrence rate （risk ratio ［RR］=1.59， 95% confidence interval ［CI］： 1.08‍ ‍—‍ ‍2.33， P=0.017） and significantly lower 1-， 3-， and 5-year disease-free survival （DFS） rates （1-year DFS rate： RR=0.94， 95%CI： 0.89‍ ‍—‍ ‍0.99， P=0.018， I2=0.0%； 3-year DFS rate： RR=0.84， 95%CI： 0.72‍ ‍—‍ ‍0.98， P=0.023， I2=25.4%； 5-year DFS rate： RR=0.75， 95%CI： 0.58‍ ‍—‍ ‍0.98， P=0.032， I2=34.6%）. However， subgroup analysis showed that there were no significant differences between MWA and HR in 1-， 2-， and 3-year OS rates and 1- and 3-year DFS rates in the RCT subgroup （all P>0.05）. Compared with HR， MWA had significantly better intraoperative blood loss （standardized mean difference ［SMD］=-2.31， 95%CI： -2.64 to -1.97， P<0.001， I2=3.1%）， time of operation （SMD=-3.38， 95%CI： -4.05 to -2.71， P<0.001， I2=73.8%）， length of hospital stay （SMD=-2.54， 95%CI： -3.27 to -1.80， P<0.001， I2=92.8%）， adverse reactions （RR=0.42， 95%CI： 0.30‍ ‍—‍ ‍0.59， P<0.001， I2=0.0%）， and liver function （SMD=-1.43， 95%CI： -1.89‍ ‍—‍ ‍-0.97， P<0.001）.  Conclusion  There are no significant differences between MWA and HR in local recurrence， DFS， and OS， but MWA tends to have a less intraoperative blood loss， a shorter time of operation， fewer adverse reactions， a less impact on liver function， and a shorter length of hospital stay.

     

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    • References(37)
  • [1]
    MURAI H, KODAMA T, MAESAKA K, et al. Multiomics identifies the link between intratumor steatosis and the exhausted tumor immune microenvironment in hepatocellular carcinoma[J]. Hepatology, 2023, 77( 1): 77- 91. DOI: 10.1002/hep.32573.
    [2]
    LI BH, LI YZ, ZHOU HJ, et al. Multiomics identifies metabolic subtypes based on fatty acid degradation allocating personalized treatment in hepatocellular carcinoma[J]. Hepatology, 2024, 79( 2): 289- 306. DOI: 10.1097/HEP.0000000000000553.
    [3]
    SANKAR K, GONG J, OSIPOV A, et al. Recent advances in the management of hepatocellular carcinoma[J]. Clin Mol Hepatol, 2024, 30( 1): 1- 15. DOI: 10.3350/cmh.2023.0125.
    [4]
    HILL A, OLUMBA F, CHAPMAN W. Transplantation for hepatocellular carcinoma[J]. Surg Clin North Am, 2024, 104( 1): 103- 111. DOI: 10.1016/j.suc.2023.09.002.
    [5]
    YILMA M, MEHTA N. Optimal liver transplantation criteria for hepatocellular carcinoma[J]. Surg Oncol Clin N Am, 2024, 33( 1): 133- 142. DOI: 10.1016/j.soc.2023.06.011.
    [6]
    TRAN NH, MUÑOZ S, THOMPSON S, et al. Hepatocellular carcinoma downstaging for liver transplantation in the era of systemic combined therapy with anti-VEGF/TKI and immunotherapy[J]. Hepatology, 2022, 76( 4): 1203- 1218. DOI: 10.1002/hep.32613.
    [7]
    KARDASHIAN A, FLORMAN SS, HAYDEL B, et al. Liver transplantation outcomes in a U.S. multicenter cohort of 789 patients with hepatocellular carcinoma presenting beyond Milan criteria[J]. Hepatology, 2020, 72( 6): 2014- 2028. DOI: 10.1002/hep.31210.
    [8]
    IVANICS T, CLAASEN MPAW, SAMSTEIN B, et al. Living donor liver transplantation for hepatocellular carcinoma within and outside traditional selection criteria: A multicentric North American experience[J]. Ann Surg, 2024, 279( 1): 104- 111. DOI: 10.1097/SLA.0000000000006049.
    [9]
    CHOI J, JO C, LIM YS. Tenofovir versus entecavir on recurrence of hepatitis B virus-related hepatocellular carcinoma after surgical resection[J]. Hepatology, 2021, 73( 2): 661- 673. DOI: 10.1002/hep.31289.
    [10]
    ZHU P, LIAO W, ZHANG WG, et al. A prospective study using propensity score matching to compare long-term survival outcomes after robotic-assisted, laparoscopic, or open liver resection for patients with BCLC stage 0-a hepatocellular carcinoma[J]. Ann Surg, 2023, 277( 1): e103- e111. DOI: 10.1097/SLA.0000000000005380.
    [11]
    RASIC G, de GEUS SWL, BEAULIEU-JONES B, et al. A nationwide propensity score analysis comparing ablation and resection for hepatocellular carcinoma[J]. J Surg Oncol, 2023, 127( 7): 1125- 1134. DOI: 10.1002/jso.27232.
    [12]
    XU JB, QI FZ, XU G, et al. Adjuvant interferon therapy after surgical treatment for hepatitis B/C virus-related hepatocellular carcinoma: A meta-analysis[J]. Hepatol Res, 2014, 44( 2): 209- 217. DOI: 10.1111/hepr.12109.
    [13]
    YANG S, LIN Q, LIN W, et al. Effect of adjuvant interferon therapy on hepatitis B virus-related hepatocellular carcinoma: A systematic review[J]. World J Surg Oncol, 2016, 14( 1): 159. DOI: 10.1186/s12957-016-0912-7.
    [14]
    ADWAN H, HAMMANN L, VOGL TJ. Microwave ablation of recurrent hepatocellular carcinoma after curative surgical resection[J]. J Clin Med, 2023, 12( 7): 2560. DOI: 10.3390/jcm12072560.
    [15]
    RYU T, TAKAMI Y, WADA Y, et al. Combined hepatectomy and microwave ablation for multifocal hepatocellular carcinoma: Long-term outcomes and prognostic factors[J]. Asian J Surg, 2021, 44( 1): 186- 191. DOI: 10.1016/j.asjsur.2020.05.008.
    [16]
    WANG Z, LIU M, ZHANG DZ, et al. Microwave ablation versus laparoscopic resection as first-line therapy for solitary 3-5-cm HCC[J]. Hepatology, 2022, 76( 1): 66- 77. DOI: 10.1002/hep.32323.
    [17]
    WICKS JS, DALE BS, RUFFOLO L, et al. Comparable and complimentary modalities for treatment of small-sized HCC: Surgical resection, radiofrequency ablation, and microwave ablation[J]. J Clin Med, 2023, 12( 15): 5006. DOI: 10.3390/jcm12155006.
    [18]
    LIU KW, ZHENG H, SUI XZ, et al. Microwave ablation versus surgical resection for subcapsular hepatocellular carcinoma: A propensity score-matched study of long-term therapeutic outcomes[J]. Eur Radiol, 2023, 33( 3): 1938- 1948. DOI: 10.1007/s00330-022-09135-1.
    [19]
    DING WZ, YU J, LIU FY, et al. Percutaneous microwave ablation versus robot-assisted hepatectomy for early hepatocellular carcinoma: A real-world single-center study[J]. Dig Liver Dis, 2022, 54( 2): 243- 250. DOI: 10.1016/j.dld.2021.04.008.
    [20]
    TONG Y, CAI R, LI JX, et al. Liver resection versus microwave ablation for hepatocellular carcinoma in ideal candidates for ablation per Barcelona Clinic Liver Cancer staging: A propensity score matching and inverse probability of treatment weighting analysis[J]. Aliment Pharmacol Ther, 2022, 56( 11-12): 1602- 1614. DOI: 10.1111/apt.17263.
    [21]
    WANG WQ, LV X, LI J, et al. Repeat hepatectomy versus microwave ablation for solitary and small(≤3 cm) recurrent hepatocellular carcinoma with early or late recurrence: A propensity score matched study[J]. Eur J Surg Oncol, 2023, 49( 5): 1001- 1008. DOI: 10.1016/j.ejso.2022.12.016.
    [22]
    LIN YZ, SHI HY, MU XH. Diagnosis of small primary liver cancer under the background of liver cirrhosis by dual-source CT hepatic artery three-phase scanning and enhanced perfusion scanning[J]. J Pract Hepatol, 2023, 26( 3): 412- 415. DOI: 10.3969/j.issn.1672-5069.2023.03.028.

    林永祝, 史红媛, 穆西虎. 双源CT肝动脉三期扫描和增强灌注扫描诊断肝硬化背景下小原发性肝癌价值研究[J]. 实用肝脏病杂志, 2023, 26( 3): 412- 415. DOI: 10.3969/j.issn.1672-5069.2023.03.028.
    [23]
    HE J, CHEN WQ, SHEN HB, et al. China guideline for liver cancer screening(2022, Beijing)[J]. J Clin Hepatol, 2022, 38( 8): 1739- 1758. DOI: 10.3969/j.issn.1001-5256.2022.08.007.

    赫捷, 陈万青, 沈洪兵, 等. 中国人群肝癌筛查指南(2022, 北京)[J]. 临床肝胆病杂志, 2022, 38( 8): 1739- 1758. DOI: 10.3969/j.issn.1001-5256.2022.08.007.
    [24]
    ZHANG QB, ZHANG XG, JIANG RD, et al. Microwave ablation versus hepatic resection for the treatment of hepatocellular carcinoma and oesophageal variceal bleeding in cirrhotic patients[J]. Int J Hyperthermia, 2017, 33( 3): 255- 262. DOI: 10.1080/02656736.2016.1257824.
    [25]
    ZHANG EL, YANG F, WU ZB, et al. Therapeutic efficacy of percutaneous microwave coagulation versus liver resection for single hepatocellular carcinoma ≤3 cm with Child-Pugh A cirrhosis[J]. Eur J Surg Oncol, 2016, 42( 5): 690- 697. DOI: 10.1016/j.ejso.2016.02.251.
    [26]
    YANG F, ZHANG EL, XIAO ZY, et al. Therapeutic outcomes of surgical resection versus percutaneous microwave coagulation therapy for single small hepatocellular carcinoma with cirrhosis(250 cases)[J]. Acta Med Univ Sci Technol Huazhong, 2016, 45( 2): 185- 189. DOI: 10.3870/j.issn.1672-0741.2016.02.014.

    杨藩, 张二雷, 肖震宇, 等. 经皮微波消融与手术切除治疗合并肝硬化的单发小肝癌的疗效比较(附250例)[J]. 华中科技大学学报(医学版), 2016, 45( 2): 185- 189. DOI: 10.3870/j.issn.1672-0741.2016.02.014.
    [27]
    HUANG Y, CHEN J, LIU XS. Clinical efficacy of laparoscopic microwave ablation in the treatment of small hepatocellular carcinoma with cirrhosis[J]. Chin J Minim Invasive Surg, 2017, 17( 6): 504- 508. DOI: 10.3969/j.issn.1009-6604.2017.06.008.

    黄炎, 陈坚, 刘绪舜. 腹腔镜微波消融治疗小肝癌合并肝硬化的临床疗效[J]. 中国微创外科杂志, 2017, 17( 6): 504- 508. DOI: 10.3969/j.issn.1009-6604.2017.06.008.
    [28]
    LIAO LF, XUE JZ, LI SK. Survival analysis of percutan eous microwave ablation for patients with small hepatocellular carcinoma with underlying liver cirrhosis[J]. J Pract Hepatol, 2018, 21( 2): 257- 260. DOI: 10.3969/j.issn.1672-5069.2018.02.025.

    廖凌峰, 薛建章, 李士坤. 经皮微波消融术治疗合并肝硬化的原发性小肝癌患者生存分析[J]. 实用肝脏病杂志, 2018, 21( 2): 257- 260. DOI: 10.3969/j.issn.1672-5069.2018.02.025.
    [29]
    CHEN HJ, CHEN Y, ZHANG SQ, et al. Comparison of microwave ablation and surgical resection in the treatment of 92 cases of small hepatocellular carcinoma complicated with cirrhosis[J]. Med J Commun, 2018, 32( 2): 163- 165.

    陈红健, 陈橼, 张素青, 等. 微波消融与手术切除治疗小肝癌合并肝硬化92例效果比较[J]. 交通医学, 2018, 32( 2): 163- 165.
    [30]
    WANG HP, JIA J. Comparative analysis of microwave ablation and surgical resection in the treatment of 90 cases of small hepatocellular carcinoma complicated with cirrhosis[J/CD]. Electron J Clin Med Lit, 2019, 6( 94): 52. DOI: 10.16281/j.cnki.jocml.2019.94.043.

    王辉坡, 贾静. 微波消融与手术切除治疗小肝癌合并肝硬化90例效果对比分析[J/CD]. 临床医药文献电子杂志, 2019, 6( 94): 52. DOI: 10.16281/j.cnki.jocml.2019.94.043.
    [31]
    HUANG ZM, ZHU CH, LI J. Clinical observation of microwave ablation and surgical resection in the treatment of small hepatocellular carcinoma with resectable cirrhosis[J]. Shenzhen J Integr Tradit Chin West Med, 2016, 26( 23): 16- 18, 199. DOI: 10.16458/j.cnki.1007-0893.2016.23.008.

    黄志明, 朱灿华, 李君. 微波消融与手术切除治疗可切除肝硬化型初治小肝癌的疗效观察[J]. 深圳中西医结合杂志, 2016, 26( 23): 16- 18, 199. DOI: 10.16458/j.cnki.1007-0893.2016.23.008.
    [32]
    WELLS G, SHEA B, O’CONNELL D, et al. The Newcastle-Ottawa Scale(NOS) for assessing the quality of nonrandomised studies in meta-analyses[EB/OL]. http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp. http: //www.ohri.ca/programs/clinical_epidemiology/oxford.asp
    [33]
    HIGGINS J, THOMAS J, CHANDLER J, et al. Cochrane Handbook for Systematic Reviews of Interventions Version 6.3, 2022[EB/OL]. http://training.cochrane.org/handbook/current. http: //training.cochrane.org/handbook/current
    [34]
    General Office of National Health Commission. Standard for diagnosis and treatment of primary liver cancer(2022 edition)[J]. J Clin Hepatol, 2022, 38( 2): 288- 303. DOI: 10.3969/j.issn.1001-5256.2022.02.009.

    国家卫生健康委办公厅. 原发性肝癌诊疗指南(2022年版)[J]. 临床肝胆病杂志, 2022, 38( 2): 288- 303. DOI: 10.3969/j.issn.1001-5256.2022.02.009.
    [35]
    XIONG K, ZHU LP, LU Y, et al. Network Meta-analysis on the efficacy and safety of surgical resection and thermal ablations for hepatocellular carcinoma in China[J]. Chin J Hepatobiliary Surg, 2019, 25( 11): 823- 827. DOI: 10.3760/cma.j.issn.1007-8118.2019.11.007.

    熊琨, 朱莉萍, 陆勇, 等. 我国肝细胞癌手术切除与热消融疗效和安全性比较的网络荟萃分析[J]. 中华肝胆外科杂志, 2019, 25( 11): 823- 827. DOI: 10.3760/cma.j.issn.1007-8118.2019.11.007.
    [36]
    ZHANG T, HU H, JIA YS, et al. Efficacy and safety of radiofrequency ablation and surgery for hepatocellular carcinoma in patients with cirrhosis: A meta-analysis[J]. Medicine, 2022, 101( 52): e32470. DOI: 10.1097/MD.0000000000032470.
    [37]
    WANG WX, ZHANG FZ, XU XX, et al. Comparison on efficacy of TACE combined with radiofrequency ablation or microwave ablation for primary hepatocellular carcinoma: Meta-analysis[J]. Chin J Interv Imag Ther, 2023, 20( 8): 467- 472. DOI: 10.13929/j.issn.1672-8475.2023.08.005.

    王文轩, 张福洲, 徐晓雪, 等. 对比TACE联合射频消融与联合微波消融治疗原发性肝细胞癌效果:Meta分析[J]. 中国介入影像与治疗学, 2023, 20( 8): 467- 472. DOI: 10.13929/j.issn.1672-8475.2023.08.005.
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