Skip to main content
SpringerLink
Log in

Microwave ablation for the treatment of hepatocellular carcinoma that met up-to-seven criteria: feasibility, local efficacy and long-term outcomes

  • Hepatobiliary-Pancreas
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

This study aimed to evaluate the feasibility, local efficacy and long-term outcomes of microwave (MW) ablation for the treatment of hepatocellular carcinoma (HCC) that met up-to-seven criteria.

Methods

Between January 2007 and January 2012, 142 HCC patients with 294 nodules, which conformed to up-to-seven criteria, were enrolled into this retrospective study. All patients were followed up for more than 3 years after receiving MW ablation. Technical success, complications, local tumour progression (LTP) and distant recurrence (DR) were monitored. Recurrence-free survival (RFS), overall survival (OS) and prognostic factors were analysed.

Results

Primary technical efficacy was achieved in 95.2% (280/294) of the carcinomatous nodules, and major complications occurred in four (2.8%) patients. Among the 294 tumours, LTP was observed in 44 (15.0%) tumours. Among the 142 patients, DR was observed in 97 (68.3%) patients. The estimated OS rates after MW ablation at 1, 3 and 5 years were 97.2%, 75.4% and 50.6%, respectively; and the corresponding RFS rates were 76.1%, 33.1% and 19.5%, respectively.

Conclusions

MW ablation is a safe and effective treatment with a high rate of primary technical efficacy for patients with HCC that met up-to-seven criteria.

Key Points

• The first study expanding MW ablation to HCC category beyond Milan criteria.

• The first report that used up-to-seven criteria as indications for MW ablation.

• HCC of up-to-seven criteria viewed as a subgroup of BCLC stage B.

• MW ablation is safe and effective for treating HCC within up-to-seven criteria.

• MW ablation is preferable in treating unresectable HCC within up-to-seven criteria.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D (2011) Global cancer statistics. CA Cancer J Clin 61:69–90

    Article  PubMed  Google Scholar 

  2. Mazzaferro V, Regalia E, Doci R et al (1996) Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. New Engl J Med 334:693–700

    Article  CAS  PubMed  Google Scholar 

  3. Bruix J, Sherman M (2011) Management of hepatocellular carcinoma, an update. Hepatology 53:1020–1022

    Article  PubMed  PubMed Central  Google Scholar 

  4. Takuma Y, Takabatake H, Morimoto Y et al (2013) Comparison of combined transcatheter arterial chemoembolization and radiofrequency ablation with surgical resection by using propensity score matching in patients with hepatocellular carcinoma within Milan criteria. Radiology 269:927–937

    Article  PubMed  Google Scholar 

  5. Shi J, Sun Q, Wang Y et al (2014) Comparison of microwave ablation and surgical resection for treatment of hepatocellular carcinomas conforming to Milan criteria. J Gastroen Hepatol 29:1500–1507

    Article  Google Scholar 

  6. Huang J, Yan L, Cheng Z et al (2010) A randomized trial comparing radiofrequency ablation and surgical resection for HCC conforming to the Milan criteria. Ann Surg 252:903–912

    Article  PubMed  Google Scholar 

  7. Lee HS (2007) Liver transplantation for hepatocellular carcinoma beyond the Milan criteria: the controversies continue. Dig Dis 25:296–298

    Article  PubMed  Google Scholar 

  8. Yao FY (2008) Liver transplantation for hepatocellular carcinoma: beyond the Milan criteria. Am J Transplant 8:1982–1989

    Article  CAS  PubMed  Google Scholar 

  9. Mazzaferro V, Llovet JM, Miceli R et al (2009) Predicting survival after liver transplantation in patients with hepatocellular carcinoma beyond the Milan criteria: a retrospective, exploratory analysis. Lancet Oncol 10:35–43

    Article  PubMed  Google Scholar 

  10. Wright AS, Sampson LA, Warner TF, Mahvi DM, Lee FT Jr (2005) Radiofrequency versus microwave ablation in a hepatic porcine model. Radiology 236:132–139

    Article  PubMed  Google Scholar 

  11. Qian GJ, Wang N, Shen Q et al (2012) Efficacy of microwave versus radiofrequency ablation for treatment of small hepatocellular carcinoma: experimental and clinical studies. Eur Radiol 22:1983–1990

    Article  PubMed  Google Scholar 

  12. Martin RCG, Scoggins CR, McMasters KM (2010) Safety and efficacy of microwave ablation of hepatic tumors: a prospective review of a 5-year experience. Ann Surg Oncol 17:171–178

    Article  PubMed  Google Scholar 

  13. Yin XY, Xie XY, Lu MD et al (2009) Percutaneous thermal ablation of medium and large hepatocellular carcinoma long-term outcome and prognostic factors. Cancer 115:1914–1923

    Article  CAS  PubMed  Google Scholar 

  14. Bruix J, Sherman M, Llovet JM et al (2001) Clinical management of hepatocellular carcinoma. Conclusions of the Barcelona-2000 EASL conference. European Association for the Study of the Liver. J Hepatol 35:421–430

    Article  CAS  PubMed  Google Scholar 

  15. Teratani T, Yoshida H, Shiina S et al (2006) Radiofrequency ablation for hepatocellular carcinoma in so-called high-risk locations. Hepatology 2006:1101–1108

    Article  Google Scholar 

  16. Ahmed M, Solbiati L, Brace CL et al (2014) Image-guided tumor ablation: standardization of terminology and reporting criteria–a 10-year update. Radiology 273:241–260

    Article  PubMed  PubMed Central  Google Scholar 

  17. LencioniR CXP, Dagher L, Venook AP (2010) Treatment of intermediate/advanced hepatocellular carcinoma in the clinic: how can outcomes be improved? Oncologist 15(Suppl 4):S42–S52

    Article  Google Scholar 

  18. Biolato M, Marrone G, Racco S et al (2010) Transarterial chemoembolization (TACE) for unresectable HCC: a new life begins? Eur Rev Med Pharmaco Sci 14:356–362

    CAS  Google Scholar 

  19. Lencioni R, Cioni D, Crocetti L et al (2005) Early stage hepatocellular carcinoma in patients with cirrhosis: long-term results of percutaneous image-guided radiofrequency ablation. Radiology 234:961–967

    Article  PubMed  Google Scholar 

  20. Liang P, Wang Y, Yu XL, Dong BW (2009) Malignant liver tumors: treatment with percutaneous microwave ablation - complications among cohort of 1136 patients. Radiology 251:933–940

    Article  PubMed  Google Scholar 

  21. Kim YS, Rhim H, Cho OK, Koh BH, Kim Y (2006) Intrahepatic recurrence after percutaneous radiofrequency ablation of hepatocellular carcinoma: analysis of the pattern and risk factors. Eur J Radiol 59:432–441

    Article  CAS  PubMed  Google Scholar 

  22. Yu J, Liang P, Yu X et al (2015) Local tumor progression after ultrasound-guided microwave ablation of liver malignancies: risk factors analysis of 2529 tumors. Eur Radiol 25:1119–1126

    Article  PubMed  Google Scholar 

  23. Mulier S, Ni Y, Jamart J, Ruers T, Marchal G, Michel L (2005) Local recurrence after hepatic radiofrequency coagulation: multivariate meta-analysis and review of contributing factors. Ann Surg 242:158–171

    Article  PubMed  PubMed Central  Google Scholar 

  24. Lu XY, Xi T, Lau WY et al (2011) Pathobiological features of small hepatocellular carcinoma: correlation between tumor size and biological behavior. J Cancer Res Clin 137:567–575

    Article  Google Scholar 

  25. Weinmann A, Koch S, Sprinzl M et al (2015) Survival analysis of proposed BCLC‐B subgroups in hepatocellular carcinoma patients. Liver Int 35:591–600

    Article  PubMed  Google Scholar 

  26. Kim JM, Kwon CHD, Joh JW et al (2010) Patients with unresectable hepatocellular carcinoma beyond Milan criteria: should we perform transarterial chemoembolization or liver transplantation? Transpl P 42:821–824

    Article  CAS  Google Scholar 

  27. Hsu CY, Hsia CY, Huang YH et al (2012) Comparison of surgical resection and transarterial chemoembolization for hepatocellular carcinoma beyond the Milan criteria: a propensity score analysis. Ann Surg Oncol 19:842–849

    Article  PubMed  Google Scholar 

  28. Liu W, Zhou JG, Sun Y et al (2015) Hepatic resection improved the long-term survival of patients with BCLC stage B hepatocellular carcinoma in Asia: a systematic review and meta-analysis. J Gastrointest Surg 19:1271–1280

    Article  PubMed  Google Scholar 

  29. Lei Y, Hui L, Li AJ et al (2014) Partial hepatectomy versus transcatheter arterial chemoembolization for resectable multiple hepatocellular carcinoma beyond Milan criteria: a RCT. J Hepatol 61:82–88

    Article  Google Scholar 

  30. Bolondi L, Burroughs A, Dufour JF et al (2012) Heterogeneity of patients with intermediate (BCLC B) hepatocellular carcinoma: proposal for a subclassification to facilitate treatment decisions. Semin Liver Dis 32:348–359

    CAS  PubMed  Google Scholar 

  31. Ha Y, Shim JH, Kim SO, Kim KO, Lim YS, Lee HC et al (2014) Clinical appraisal of the recently proposed Barcelona Clinic Liver Cancer stage B subclassification by survival analysis. J Gastroen Hepatol 29:787–793

    Article  Google Scholar 

  32. Ciria R, López-Cillero P, Gallardo AB et al (2015) Optimizing the management of patients with BCLC stage-B hepatocellular carcinoma: modern surgical resection as a feasible alternative to transarterial chemoemolization. Eur J Surg Oncol 41:1153–1161

    Article  CAS  PubMed  Google Scholar 

  33. Zhou L, Rui JA, Wang SB et al (2011) Prognostic factors of solitary large hepatocellular carcinoma, the importance of differentiation grade. Eur J Surg Oncol 37:521–525

    Article  CAS  PubMed  Google Scholar 

  34. Zhong JH, Rodriguez AC, Ke Y (2015) Hepatic resection as a safe and effective treatment for hepatocellular carcinoma involving a single large tumor, multiple tumors, or macrovascular invasion. Medicine 94, e396

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Goh BKP, Chow PKH, Teo JY et al (2014) Number of nodules, Child-Pugh status, margin positivity, and microvascular invasion, but not tumor size, are prognostic factors of survival after liver resection for multifocal hepatocellular carcinoma. J Gastrointest Surg 18:1477–1485

    Article  PubMed  Google Scholar 

  36. Chen X, Zhang B, Yin X, Ren Z, Qiu S, Zhou J (2013) Lipiodolized transarterial chemoembolization in hepatocellular carcinoma patients after curative resection. J Cancer Res Clin Oncol 139:773–781

    Article  CAS  PubMed  Google Scholar 

  37. Arrieta O, Cacho B, Morales-Espinosa D, Ruelas-Villavicencio A, Flores-Estrada D, Hernandez-Pedro N (2007) The progressive elevation of alpha fetoprotein for the diagnosis of hepatocellular carcinoma in patients with liver cirrhosis. BMC Cancer 8, e28

    Article  Google Scholar 

  38. Portolani N, Coniglio A, Ghidoni S et al (2006) Early and late recurrence after liver resection for hepatocellular carcinoma: prognostic and therapeutic implications. Ann Surg 243:229–235

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Author notes

    Authors and Affiliations

    1. Department of minimal invasion therapy, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University of Chinese PLA, 225 Changhai Rd, Shanghai, 200438, China

      Yun Xu, Qiang Shen, Pei Liu, Zhongqi Xu, Panpan Wu, Zhenghua Lu, Yi Chen & Guojun Qian

    2. Department of radiology, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University of Chinese PLA, 225 Changhai Rd, Shanghai, 200438, China

      Bin Huang

    Authors
    1. Yun Xu
      View author publications

      You can also search for this author in PubMed Google Scholar

    2. Qiang Shen
      View author publications

      You can also search for this author in PubMed Google Scholar

    3. Pei Liu
      View author publications

      You can also search for this author in PubMed Google Scholar

    4. Zhongqi Xu
      View author publications

      You can also search for this author in PubMed Google Scholar

    5. Panpan Wu
      View author publications

      You can also search for this author in PubMed Google Scholar

    6. Zhenghua Lu
      View author publications

      You can also search for this author in PubMed Google Scholar

    7. Yi Chen
      View author publications

      You can also search for this author in PubMed Google Scholar

    8. Bin Huang
      View author publications

      You can also search for this author in PubMed Google Scholar

    9. Guojun Qian
      View author publications

      You can also search for this author in PubMed Google Scholar

    Corresponding author

    Correspondence to Guojun Qian.

    Ethics declarations

    Guarantor

    The scientific guarantor of this publication is Guojun Qian.

    Conflict of interest

    The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

    Funding

    The authors state that this work has not received any funding.

    Statistics and biometry

    One of the authors: Yun Xu has significant statistical expertise.

    Ethical approval

    Institutional review board approval was obtained.

    Informed consent

    Written informed consent was obtained from all subjects (patients) in this study.

    Study subjects or cohorts overlap

    No study subjects or cohorts have been previously reported.

    Methodology

    • retrospective

    • prognostic study

    • performed at one institution

    Additional information

    Yun Xu and Qiang Shen contributed equally to this work.

    Rights and permissions

    Reprints and permissions

    About this article

    Check for updates. Verify currency and authenticity via CrossMark

    Cite this article

    Xu, Y., Shen, Q., Liu, P. et al. Microwave ablation for the treatment of hepatocellular carcinoma that met up-to-seven criteria: feasibility, local efficacy and long-term outcomes. Eur Radiol 27, 3877–3887 (2017). https://doi.org/10.1007/s00330-017-4740-0

    Download citation

    • Received:

    • Revised:

    • Accepted:

    • Published:

    • Issue Date:

    • DOI: https://doi.org/10.1007/s00330-017-4740-0

    Keywords

    Search

    Navigation