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.
Hierarchically Positioning Laparoscopic Microwave Ablation in the Therapeutic Span of Early Hepatocellular Carcinoma: A Real-Life Comparative Analysis / Cillo, U.; Caregari, S.; Barabino, M.; Billato, I.; Marchini, A.; Furlanetto, A.; Lazzari, S.; Brolese, M.; Ballo, M.; Biasini, E.; Celsa, C.; Sangiovanni, A.; Foschi, F. G.; Campani, C.; Vidili, G.; Saitta, C.; Piscaglia, F.; Brunetto, M. R.; Masotto, A.; Farinati, F.; Trevisani, F.; Zappa, M. A.; Vitale, A.; Santambrogio, R.; Renzulli, M.; Mosconi, C.; Golfieri, R.; Cappelli, A.; Malerba, A.; Coccoli, P.; Marchetti, F.; Inno, A.; Ravaioli, F.; Dajti, E.; Sauchella, A.; Dell'Isola, S.; Ortenzi, M.; Coratella, F.; Chegai, F.; Pelecca, G.; Ghittoni, G.; Lauria, V.; Facciorusso, A.; Cela, E. M.; Sacco, R.; Morisco, F.; Capasso, M.; Cossiga, V.; Dambina, V.; Rabatelli, P.; Missale, G.; Olivani, A.; Ponziani, F. R.; De Matthaeis, N.; Migliano, M. T.; Domenicali, M.; Napoli, L.; Conti, F.; Casadei Gardini, A.; Borghi, A.; Bevilacqua, V.; Cavoli, T. L.; Rosi, M.; Adotti, V.; Marra, F.; Grassini, M. V.; Rancatore, G.; Giacchetto, C. M.; Grova, M.; Stornello, C.; Giuffrida, P.; Cabibbo, G.; Camma, C.; Allegrini, G.; Iavarone, M.; Pinto, E.; Penzo, B.; Pelizzaro, F.; Palano, G.; Bertellini, F.; Muratori, L.; Granito, A.; Benevento, F.; Stefanini, B.; Santi, V.; Lani, L.; Caraceni, P.; Biselli, M.. - In: ANNALS OF SURGICAL ONCOLOGY. - ISSN 1068-9265. - 32:2(2025), pp. 1063-1072. [10.1245/s10434-024-16462-8]
Hierarchically Positioning Laparoscopic Microwave Ablation in the Therapeutic Span of Early Hepatocellular Carcinoma: A Real-Life Comparative Analysis
Lazzari S.;Trevisani F.;Conti F.;Casadei Gardini A.;
2025-01-01
Abstract
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.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
