Percutaneous Cryoablation Versus Microwave Ablation for Hepatocellular Carcinoma: Comparative Study of Safety and...

Purpose To compare safety and oncologic outcomes of percutaneous image-guided hepatic cryoablation and microwave ablation (MWA) for treating hepatocellular carcinoma (HCC). Materials and Methods This single center, retrospective study evaluated percutaneous image-guided cryoablation and MWA procedures in patients with HCC from December 2015 to December 2023. Adverse events (AEs) were recorded per procedure. Technical success and local tumor progression-free survival were assessed per tumor and compared after propensity score matching. Intrahepatic progression-free survival, extrahepatic progression-free survival, and overall survival were measured per patient when cryoablation or MWA was used as the initial curative-intent treatment for early-stage HCC. Survival metrics were estimated using Kaplan-Meier curves and compared using log-rank testing. Results A total of 176 ablation procedures in 123 patients with 228 HCCs enabled three cohort analyses (mean age ± SD, 69 years ± 9; 85 male). Per-procedure AE analysis of 170 procedures (69 cryoablation and 101 MWA) showed no evidence of differences in overall or major AE rates (cryoablation: overall AEs, 19%, major AEs, 1%; MWA: overall AEs, 10%, major AEs, 3%; P = .60). After propensity score matching, 158 HCC tumors were studied (79 cryoablation and 79 MWA): technical success for both modalities was 97% (P = .96); 3-year per-tumor local tumor progression-free survival rates were 57% for cryoablation and 58% for MWA (P = .53). Per-patient analysis of 51 patients with early-stage HCC (17 cryoablation and 34 MWA) yielded 1-year intrahepatic progression-free survival, extrahepatic progression-free survival, and overall survival rates of 82%, 88%, and 100% for cryoablation and 73%, 94%, and 88% for MWA, respectively, without evidence of a difference in any survival outcome (P = .76). Conclusion Percutaneous cryoablation and MWA demonstrated similar favorable safety and oncologic outcomes for initial treatment of HCC. Keywords: Comparative Studies, Ablation Techniques, CT, Interventional-Oncology, Abdomen/GI, Liver © RSNA, 2026.