Chen Kaige, Ji Yimin, Wang Gongzheng, Chen Wen, Zhu Qiang, Wang Ximing, Liu Cuihong, Zhao Xinya
Department of Ultrasound, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China.
Department of Radiology, Qilu Hospital of Shandong University, Jinan, China.
Korean J Radiol. 2025 Jul;26(7):650-659. doi: 10.3348/kjr.2025.0049.
To compare the efficacy of microwave ablation (MWA) and surgical resection (SR) for small (≤3 cm) hepatocellular carcinoma (HCC) in older patients.
This retrospective study initially enrolled 319 patients who were aged ≥65 years, had a single HCC ≤3 cm, and had Child-Pugh class A or B. Of these, 108 received MWA and 211 received SR. Overall survival (OS), disease-free survival (DFS), local tumor progression (LTP), complications, and postoperative hospital stay were compared between the groups. Hazard ratios (HRs) were estimated using the SR group as reference. Propensity score matching (PSM) was used to minimize confounding biases.
After PSM, 80 patients each were included in the MWA and SR groups. There were no statistically significant differences in the 1-, 3-, and 5-year OS rates (MWA: 96.2%, 80.3%, and 55.4%, respectively; SR: 91.3%, 81.4%, and 64.8%, respectively; HR = 1.06; 95% confidence interval [CI], 0.61-1.85; = 0.839) and DFS rates (MWA: 72.4%, 43.2%, and 26.4%, respectively; SR: 78.8%, 51.2%, and 38.0%, respectively; HR = 1.27; 95% CI, 0.84-1.90; = 0.247) between the MWA and SR groups. MWA was associated with a higher LTP rate (HR = 2.96; 95% CI, 1.21-7.28; = 0.028). Additionally, older patients in the MWA group had fewer complications (52.5% vs. 97.5%, < 0.001) and shorter postoperative hospital stay (3 days vs. 6 days, < 0.001) than those in the SR group.
In older patients with a single HCC ≤3 cm, MWA was superior to SR in terms of complications and postoperative hospital stay, and there was no significant difference in the 5-year OS and DFS outcomes. Therefore, MWA may be an alternative curative treatment for such patients.
比较微波消融（MWA）与手术切除（SR）治疗老年患者小（≤3 cm）肝细胞癌（HCC）的疗效。
本回顾性研究最初纳入319例年龄≥65岁、单发HCC≤3 cm且Child-Pugh分级为A或B级的患者。其中，108例接受MWA治疗，211例接受SR治疗。比较两组患者的总生存期（OS）、无病生存期（DFS）、局部肿瘤进展（LTP）、并发症及术后住院时间。以SR组为参照估计风险比（HR）。采用倾向评分匹配（PSM）以尽量减少混杂偏倚。
PSM后，MWA组和SR组各纳入80例患者。MWA组和SR组的1年、3年和5年总生存率（分别为96.2%、80.3%和55.4%；SR组分别为91.3%、81.4%和64.8%；HR = 1.06；95%置信区间[CI]，0.61 - 1.85；P = 0.839）及无病生存率（分别为72.4%、43.2%和26.4%；SR组分别为78.8%、51.2%和38.0%；HR = 1.27；95% CI，0.84 - 1.90；P = 0.247）无统计学显著差异。MWA组的LTP发生率较高（HR = 2.96；95% CI，1.21 - 7.28；P = 0.028）。此外，MWA组老年患者的并发症少于SR组（52.5%对97.5%，P < 0.001），术后住院时间短于SR组（3天对6天，P < 0.001）。
对于单发HCC≤3 cm的老年患者，MWA在并发症及术后住院时间方面优于SR，5年总生存和无病生存结局无显著差异。因此，MWA可能是这类患者的一种替代性根治性治疗方法。
