Prognostic factors for survival after transarterial chemoembolization combined with microwave ablation for hepatocellular carcinoma

Abstract

Aim: To analyze prognostic factors for survival after transarterial chemoembolization (TACE) combined with microwave ablation (MWA) for hepatocellular carcinoma (HCC).

Methods: Clinical data of 86 patients who underwent TACE combined with MWA between January 2006 and December 2013 were retrospectively analyzed in this study. Survival curves were detected using log-rank test. Univariate analysis was performed using log-rank test with respect to 13 prognostic factors affecting survival. All statistically significant prognostic factors identified by univariate analysis were entered into a Cox proportion hazards regression model to identify independent predictors of survival. P values were two-sided and P < 0.05 was considered statistically significant.

Results: Median follow-up time was 47.6 mo, and median survival time of enrolled patients was 21.5 mo. The 1-, 2-, 3- and 5-year overall survival rates were 72.1%, 44.1%, 31.4% and 13.9%, respectively. Tumor size(χ(2) = 14.999, P = 0.000), Barcelona Clinic Liver Cancer (BCLC) stage (χ(2) = 29.765, P = 0.000), Child-Pugh class (χ(2) = 51.820, P = 0.000), portal vein tumor thrombus (PVTT) (χ(2) = 43.086, P = 0.000), arterio-venous fistula (χ(2) = 29.791, P = 0.000), MWA therapy times (χ(2) = 12.920, P = 0.002), Eastern Cooperative Oncology Group (ECOG) score (χ(2) = 28.660, P = 0.000) and targeted drug usage (χ(2) = 10.901, P = 0.001) were found to be significantly associated with overall survival by univariate analysis. Multivariate analysis identified that tumor size (95%CI: 1.608-4.962, P = 0.000), BCLC stage (95%CI: 1.016-2.208, P = 0.020), PVTT (95%CI: 2.062-9.068, P = 0.000), MWA therapy times (95%CI: 0.402-0.745, P = 0.000), ECOG score (95%CI: 1.012-3.053, P = 0.045) and targeted drug usage (95%CI: 1.335-3.143, P = 0.001) were independent prognostic factors associated with overall survival.

Conclusion: Superior performance status, MWA treatment and targeted drug were favorable factors, and large HCC, PVTT and advanced BCLC stage were risk factors for survival after TACE-MWA for HCC.

Keywords: Hepatocellular carcinoma; Microwave ablation; Prognosis; Survival; Transarterial chemoembolization.

Figures

Figure 1

Overall survival curve of 86 patients who underwent transarterial chemoembolization-microwave ablation. TACE: Transarterial chemoembolization; MWA: Microwave ablation.

Figure 2

Survival curves of 86 patients with different prognostic factors. A: Patients with different sizes of hepatocellular carcinoma (HCC); B: Patients with different stages of Barcelona Clinic Liver Cancer; C: Patients with different types of portal vein tumor thrombus; D: Patients with different times of microwave ablation treatment; E: Patients with different Eastern Cooperative Oncology Group scores; F: Patients with and without therapy with targeted drugs.