Hierarchically Positioning Laparoscopic Microwave Ablation in the Therapeutic Span of Early Hepatocellular Carcinoma: A Real-Life Comparative Analysis

期刊论文
发表日期：

2024年12月10日

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Umberto Cillo,
Silvia Caregari,
Matteo Barabino,
Ilaria Billato,
Andrea Marchini,
Alessandro Furlanetto,
Sara Lazzari,
Marco Brolese,
Mattia Ballo,
Elisabetta Biasini,
Ciro Celsa,
Angelo Sangiovanni,
Francesco Giuseppe Foschi,
Claudia Campani,
Gianpaolo Vidili,
Carlo Saitta,
Fabio Piscaglia,
Maurizia Rossana Brunetto,
Alberto Masotto,
Fabio Farinati,
Franco Trevisani,
Marco Antonio Zappa,
Alessandro Vitale,
Roberto Santambrogio,
Maurizio Biselli,
Paolo Caraceni,
Lorenzo Lani,
Valentina Santi,
Benedetta Stefanini,
Francesca Benevento,
Alessandro Granito,
Luca Muratori,
Federica Bertellini,
Giorgio Palano,
Filippo Pelizzaro,
Barbara Penzo,
Elisa Pinto,
Massimo Iavarone,
Gloria Allegrini,
Calogero Cammà,
Giuseppe Cabibbo,
Paolo Giuffrida,
Caterina Stornello,
Mauro Grova,
Carmelo Marco Giacchetto,
Gabriele Rancatore,
Maria Vittoria Grassini,
Fabio Marra,
Valentina Adotti,
Martina Rosi,
Tancredi Li Cavoli,
Vittoria Bevilacqua,
Alberto Borghi,
Andrea Casadei Gardini,
Fabio Conti,
Lucia Napoli,
Marco Domenicali,
Maria Teresa Migliano,
Nicoletta de Matthaeis,
Francesca Romana Ponziani,
Andrea Olivani,
Gabriele Missale,
Paola Rabatelli,
Valeria Dambina,
Valentina Cossiga,
Mario Capasso,
Filomena Morisco,
Rodolfo Sacco,
Ester Marina Cela,
Antonio Facciorusso,
Valentina Lauria,
Giorgia Ghittoni,
Giorgio Pelecca,
Fabrizio Chegai,
Fabio Coratella,
Mariano Ortenzi,
Serena Dell’Isola,
Assunta Sauchella,
Elton Dajti,
Federico Ravaioli,
Alessandro Inno,
Fabiana Marchetti,
Pietro Coccoli,
Antonio Malerba,
Alberta Cappelli,
Rita Golfieri,
Cristina Mosconi,
Matteo Renzulli

摘要

Background

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.

Methods

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.

Results

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.

Conclusions

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.