Sequential therapy of TACE followed by percutaneous microwave coagulation for early-stage primary hepatocellular carcinomas：curative effect and prognostic factors / 介入放射学杂志

ABSTRACT

Objective To explore the effect of sequential therapy of transcatheter arterial chemoembolization (TACE) followed by percutaneous microwave coagulation therapy (PMCT) in treating early-stage primary hepatocellular carcinoma (PHC), and to analyze the factors that may affect the prognosis. Methods During the period from Jan. 2011 to Apr. 2014, a total of 66 patients with early-stage PHC were admitted to authors’ hospital. TACE was carried out in all patients, which was followed by PMCT in 5 -7 days. All patients were followed up regularly. CT, MR, ultrasonography, AFP, liver function and other related laboratory tests were performed. Kaplan-Meier estimation was used for the analysis of disease-free survival time. The high-risk factors were analyzed by Chi-square test. Multivariate analysis was conducted by using logistic analysis method. Results After TACE the serum levels of ALT, TBIL and DBIL were increased significantly when compared with preoperative ones (P< 0.01). After sequential PMCT the serum levels of AST, ALT and DBIL were increased significantly when compared with preoperative ones (P< 0.01). When compared with TACE, after sequential PMCT the serum level of AST was increased (P< 0.01), while serum levels of TBIL and DBIL were decreased (P< 0.01). Compared with TACE and preoperative data, the post-PMCT AFP level was decreased (P < 0.01). During the follow-up period one patient died. The 3-year cumulative survival rate was 98.5%. Recurrence was seen in 19 cases. The one-year, 2-year and 3-year disease-free cumulative survival rate was 70.3%, 50.8% and 41.6% respectively. Univariate and multivariate analysis indicated that the risk factors of recurrence in early-stage PHC included AFP ≥ 100 μg/L, viral load≥103 copies/ml and irregularity of tumor border (P<0.05). Conclusion Sequential therapy of TACE followed by PMCT is an ideal treatment for early-stage PHC, sequential PMCT after TACE does not affect liver recovery process. AFP ≥ 100 μg/L, viral load ≥ 103 copies/ml and irregularity of tumor border are the risk factors of recurrence.