Cillo Umberto, Caregari Silvia, Barabino Matteo, Billato Ilaria, Marchini Andrea, Furlanetto Alessandro, Lazzari Sara, Brolese Marco, Ballo Mattia, Biasini Elisabetta, Celsa Ciro, Sangiovanni Angelo, Foschi Francesco Giuseppe, Campani Claudia, Vidili Gianpaolo, Saitta Carlo, Piscaglia Fabio, Brunetto Maurizia Rossana, Masotto Alberto, Farinati Fabio, Trevisani Franco, Zappa Marco Antonio, Vitale Alessandro, Santambrogio Roberto
General Surgery 2 Unit, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy.
Unit of HepatoBilioPancreatic and Digestive Surgery, Department of Health Sciences, San Paolo Hospital, University of Milan, Milan, Italy.
Ann Surg Oncol. 2025 Feb;32(2):1063-1072. doi: 10.1245/s10434-024-16462-8. Epub 2024 Dec 10.
Laparoscopic microwave ablation (LMWA) has yet to gain a specific place in treatment guidelines for early hepatocellular carcinoma (HCC). This study compared the outcomes of LMWA and trans-arterial chemoembolization (TACE) for early non-resectable patients with HCC, taking percutaneous radiofrequency ablation (PRFA) as the reference treatment.
A retrospective multicenter observational study was conducted, enrolling non-transplantable, non-resectable patients who had early HCC treated with LMWA (n = 658) from Padua and Milan centers, and with PRFA (n = 844), and TACE (n = 425) from the ITA.LI.CA multicenter database. The matching-adjusted indirect comparison (MAIC) method was used to obtain weighted LMWA and TACE populations similar to the reference PRFA population.
Laparoscopic ablation showed an excellent safety profile, and MAIC-weighted early postoperative deaths were comparable among the groups. The MAIC-weighted overall survival was similar between the LMWA (1-, 3-, and 5 year survival of 91.0 %, 67.9 %, 47.0 %, respectively) and PRFA (1-, 3- and 5 year survivals of 90.0 %, 64.7 %, 46.6 %, respectively) groups (p = 0.678) and significantly better for the LMWA group than for the TACE group (1-, 3- and 5 year survivals of 84.7 %, 48.8 %, 33.6 %, respectively) (p < 0.001). Weighted multivariate overall survival analysis and competing risk/subgroup analyses confirmed the non-inferiority of LMWA to PRFA and its superiority to TACE. The LMWA- and PRFA-treated patients had a significantly lower risk of HCC-related death (p = 0.004) than the TACE-treated patients (p = 0.001). Conversely, the groups did not differ significantly in terms of non-HCC-related deaths.
The non-inferiority of LMWA to PRFA, its superiority to TACE, and its applicability to a wide range of presentations with few contraindications support its inclusion among radical therapies for treating early-HCC patients.
腹腔镜微波消融术（LMWA）在早期肝细胞癌（HCC）治疗指南中尚未占据特定地位。本研究以经皮射频消融术（PRFA）作为对照治疗，比较了LMWA与经动脉化疗栓塞术（TACE）治疗早期不可切除HCC患者的疗效。
进行了一项回顾性多中心观察性研究，纳入来自帕多瓦和米兰中心接受LMWA治疗的不可移植、不可切除的早期HCC患者（n = 658），以及来自ITA.LI.CA多中心数据库接受PRFA治疗的患者（n = 844）和接受TACE治疗的患者（n = 425）。采用匹配调整间接比较（MAIC）方法获得与对照PRFA人群相似的加权LMWA和TACE人群。
腹腔镜消融显示出良好的安全性，各组间MAIC加权术后早期死亡率相当。LMWA组（1年、3年和5年生存率分别为91.0%、67.9%、47.0%）与PRFA组（1年、3年和5年生存率分别为90.0%、64.7%、46.6%）的MAIC加权总生存率相似（p = 0.678），且LMWA组显著优于TACE组（1年、3年和5年生存率分别为84.7%、48.8%、33.6%）（p < 0.001）。加权多因素总生存分析和竞争风险/亚组分析证实了LMWA不劣于PRFA且优于TACE。接受LMWA和PRFA治疗的患者与HCC相关死亡风险显著低于接受TACE治疗的患者（p = 0.004 vs p = 0.001）。相反，各组在非HCC相关死亡方面无显著差异。
LMWA不劣于PRFA，优于TACE，且适用于多种情况，禁忌证较少，这些支持将其纳入早期HCC患者的根治性治疗方法中。
