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Updated: May 11, 2026
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Published on: March 3, 2023
Microwave Ablation with or without TACE for Unresectable Large Hepatocellular Carcinoma: Impact of Tumor Burden Score
Zhen Wang1,2, Zhen Wang3,4, Jianming Li3
1Medical School of Chinese PLA, 28 Fuxing Road, Beijing, 100853, China.
Background:
Patients with unresectable large HCC may be downstaged through TACE followed by MWA to achieve curative treatment. Controversially, for some patients, single MWA treatment may be sufficient.
Purpose:
This study aimed to evaluate the clinical outcomes of unresectable large HCC treated with transarterial chemoembolization (TACE) followed by microwave ablation (MWA) and compare them based on the tumor burden score (TBS), to provide a scientific basis for guiding treatment strategies.
Methods:
This retrospective study included 294 patients with unresectable large HCC (449 tumors) treated with MWA between January 2010 and June 2023 at the General Hospital of the People's Liberation Army. Propensity score matching (PSM) was used to compare the TACE sequential MWA group (n = 103) with the single MWA group (n = 103). The primary endpoint was progression-free survival (PFS), with secondary endpoints including overall survival (OS) and occurrence of adverse events. Subgroup analyses were conducted by identifying TBS split points using the interaction cubic spline plot method.
Results:
Among the 294 patients, 76.5% were infected with hepatitis B virus (HBV), with a median age of 62.0 years and a mean maximum tumor diameter of 6.0 ± 1.1 cm. After PSM and with a median follow-up of 67.3 months, PFS was significantly worse in the single MWA group, while no significant difference was observed between the two treatments in OS or adverse events. Interaction cubic spline plot analysis indicated TBS split points of 5.7 and 7.5. A significant difference in PFS was observed when TBS was ≥ 5.7 (HR 1.91, 95% CI: 1.31-2.79, P = 0.001), and in OS when TBS was ≥ 7.5 (HR 2.75, 95% CI: 1.26-5.96, P = 0.011). Subgroup analysis revealed that the TACE sequential MWA group was more effective in controlling intrahepatic distant progression (HR 1.93, 95% CI: 1.30-2.87, P = 0.001).
Conclusion:
TACE sequential MWA demonstrates superior efficacy compared to single MWA in patients with unresectable large HCC. However, when TBS is < 5.7, the two treatments may be comparable. For TBS ≥ 7.5, the combined treatment regimen should be prioritized.
