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Published on: December 15, 2023
Three-Dimensional Margin Assessment Predicts Local Tumor Progression after Stereotactic Microwave Ablation of Small
Michael P Brönnimann1, Philippe Lauber2, Matthew L Hung3
1Department of Diagnostic, Interventional and Pediatric Radiology, Bern, Switzerland; Division of Interventional Radiology, Department of Radiology, Stanford University School of Medicine, Stanford, California.
Purpose:
To evaluate the impact of the minimal ablation margin (MAM) on local tumor progression (LTP) after stereotactic microwave ablation (MWA) of small hepatocellular carcinoma (HCC) using 3-dimensional (3D) quantitative ablation margin (QAM) assessment.
Materials And Methods:
This retrospective single-center study included 175 lesions in 115 patients with HCC of ≤3 cm treated with stereotactic MWA. The MAM was assessed using 3D-QAM analysis. Associations with LTP were evaluated using multivariable logistic regression. Model performance was assessed by receiver-operating characteristic (ROC) analysis and internally validated using bootstrap resampling. Sensitivity analyses included generalized estimating equations to account for clustering of lesions within patients. Additional analyses adjusted for reablation and included time-to-event analyses.
Results:
LTP occurred in 36 of 175 lesions (20.6%). Lesions with LTP had significantly smaller margins than those without progression (2.9 vs 4.7 mm; P < .001). The MAM was a strong independent protective factor (odds ratio, 0.68 per-millimeter increase; P < .001). Right-sided lesion location was associated with increased risk (odds ratio, 2.75; P = .045), whereas multifocality was not significant. ROC analysis showed moderate discrimination (area under the curve, 0.70). Internal validation demonstrated stable model performance with an optimism-corrected area under the ROC curve of 0.73 and good calibration (slope, 0.93). Results remained consistent in sensitivity analyses using generalized estimating equations. Time-to-event analyses confirmed the MAM-LTP-free survival association.
Conclusions:
The MAM is a key determinant of LTP after stereotactic MWA of small HCC. Margin-based risk prediction is robust and supports the clinical use of 3D margin assessment to optimize local tumor control.
Insights
A wider minimal ablation margin (MAM) significantly reduces local tumor progression (LTP) after microwave ablation (MWA) for small hepatocellular carcinoma (HCC). Three-dimensional margin assessment aids in predicting and optimizing treatment outcomes for HCC.
Area of Science:
- Hepatobiliary Surgery
- Interventional Radiology
- Oncology
Background:
- Stereotactic microwave ablation (MWA) is a treatment for small hepatocellular carcinoma (HCC).
- Assessing the ablation margin is crucial for predicting local tumor progression (LTP).
- Three-dimensional quantitative ablation margin assessment (3D-QAM) offers precise margin evaluation.
Purpose of the Study:
- To evaluate the impact of the minimal ablation margin (MAM) on local tumor progression (LTP).
- To assess the efficacy of stereotactic MWA for small HCC using 3D-QAM.
- To determine the predictive value of MAM for treatment outcomes.
Main Methods:
- Retrospective analysis of 175 HCC lesions in 115 patients treated with stereotactic MWA.
- Minimal ablation margin (MAM) assessed using 3D-QAM.
- Multivariable logistic regression and ROC analysis to evaluate associations with LTP and model performance.
Main Results:
- Local tumor progression (LTP) occurred in 20.6% of lesions.
- Smaller MAMs were significantly associated with higher LTP rates (2.9 mm vs. 4.7 mm).
- MAM was an independent protective factor (OR 0.68 per mm increase); right-sided location increased risk (OR 2.75).
Conclusions:
- The minimal ablation margin (MAM) is a critical factor in preventing local tumor progression (LTP) after stereotactic MWA for HCC.
- Margin-based risk prediction using 3D-QAM is robust and clinically applicable.
- Optimizing MAM through precise assessment can improve local tumor control in HCC treatment.
