Efficacy of transcatheter arterial chemoembolization alone or combined with microwave ablation in treatment of primary large liver cancer: a comparative analysis

Objective To retrospectively analyze the short- term efficacy and long- term survival rates of transcatheter arterial chemoembolization( TACE) combined with percutaneous microwave coagulation therapy( PMCT) versus TACE monotherapy in the treatment of large primary hepatic carcinoma. Methods Sixty- seven patients with unresectable large primary hepatic carcinoma( > 5. 0 cm) who were admitted to our hospital from February 2011 to May 2014 were enrolled as subjects. Among these patients,34 patients received TACE monotherapy and 33 patients received TACE combined with PMCT. At one month after treatment,the abdomen was re- examined using contrast-enhanced computed tomography or magnetic resonance imaging,and liver function and alpha- fetoprotein( AFP) level were measured. The follow- up period varied from 3 to 36 months. Comparison of short- term outcomes,AFP level,and long- term survival rates were performed between the two groups. Comparison of continuous data was made by t test,and comparison of categorical data by χ2test and Fisher's test. Results The complete ablation rate and the response rate were significantly higher in the combination therapy group than in the TACE monotherapy group( 54. 5% vs 20. 6%,P = 0. 004; 97% vs 64. 7%,P = 0. 001). The AFP level after treatment with combination therapy was significantly lower than that before treatment with combination therapy and that after treatment with TACE monotherapy( P < 0. 001; P <0. 001). Patients in both groups had varying degrees of liver dysfunction and elevated aminotransferase,but with no severe complications such as bleeding,gastrostoma,colon fistula,bile duct injury,and needle tract metastasis,as well as deaths. The median survival time in the combination therapy group and the TACE monotherapy group was 13 months and 9 months,respectively,and the mean survival time was14. 00 ± 1. 63 months and 10. 83 ± 1. 19 months,respectively. The 1-,2-,and 3- year overall survival rates in the combination therapy group were significantly higher than those in the TACE monotherapy group( 63. 6% vs 28. 4%; 15. 2% vs 5. 9%; 4. 5% vs 0%; P =0. 044). Conclusion TACE combined with PMCT is a safe and effective therapy regimen,which achieves better treatment outcomes in local tumor control,substantially lower AFP level,and longer survival time than TACE monotherapy.