Objective: To evaluate the long-term efficacy of percutaneous microwave ablation (MWA) therapy for hepatocellular carcinoma. Methods: 2054 cases with Barcelona Clinic Liver Cancer (BCLC) stage 0~B at the Fifth Medical Center of the Chinese People's Liberation Army General Hospital from January 2006 to September 2020 were retrospectively collected. All patients were followed up for at least 2 years. The primary endpoint of overall survival and secondary endpoints (tumor-related survival, disease-free survival, and postoperative complications) of patients treated with ultrasound-guided percutaneous MWA were analyzed. Kaplan-Meier method was used for stratified survival rate analysis. Fine-and-Gray competing risk model was used to analyze overall survival. Results: A total of 5 503 HCC nodules [mean tumor diameter (2.6±1.6) cm] underwent 3 908 MWAs between January 2006 and September 2020, with a median follow-up time of 45.6 (24.0 -79.2) months.The technical effectiveness rate of 5 375 tumor nodules was 97.5%. The overall survival rates at 5, 10, and 15-years were 61.6%, 38.8%, and 27.0%, respectively. The tumor-specific survival rates were 67.1%, 47.2%, and 37.7%, respectively. The free tumor survival rates were 25.8%, 15.7%, and 9.9%, respectively. The incidence rate of severe complications was 2.8% (108/3 908). Further analysis showed that the technical effectiveness and survival rate over the passing three time periods from January 2006-2010, 2011-2015, and 2016-September 2020 were significantly increased, with P < 0.001, especially for liver cancer 3.1~5.0 cm (P < 0.001). Conclusion: Microwave ablation therapy is a safe and effective method for BCLC stage 0-B, with significantly enhanced technical efficacy and survival rate over time.
目的： 评估经皮微波消融（MWA）治疗肝细胞癌的长期疗效。 方法： 回顾性收集2006年1月至2020年9月中国人民解放军总医院第五医学中心巴塞罗那临床肝癌（BCLC）0～B期患者2 054例，所有患者至少随访2年。分析患者超声引导经皮MWA治疗后的主要终点总生存率和次要终点（肿瘤相关生存率、无瘤生存率和术后并发症）。生存率使用Kaplan-Meier法进行分层分析。总生存使用Fine-and Gray竞争风险模型进行分析。 结果： 2006年1月至2020年9月共有5 503个肝癌结节[平均肿瘤长径（2.6±1.6）cm]接受3 908次MWA，中位随访时间为45.6 (24.0～79.2)个月，总队列的技术成功率为97.6%（5 376/5 503）。5 、10 、15年总生存率分别为61.6%、38.8%、27.0%；肿瘤特异性生存率分别为67.1%、47.2%和37.7%；无瘤生存率分别为25.8%、15.7%和9.9%；严重并发症发生率2.8%（108/3 908）。进一步分析显示，在2006-2010年、2011-2015年和2016年1月-2020年9月的3个时间段内，随时间推移，技术有效率和生存率明显增高，P值均<0.001 ，特别是对于肿瘤长径为3.1～5.0 cm的肝癌结节(P < 0.001)。 结论： 微波消融治疗对于BCLC 0～B期肝癌是一种安全有效的方法，技术有效率和生存率随时间显著提升。.
Keywords: Hepatocellular carcinoma; Microwave ablation; Real-world experience; Survival rate; Treatment.