Factors Associated with Tumor Progression After Percutaneous Ablation of Hepatocellular Carcinoma: Comparison Between Mo
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CLINICAL INVESTIGATION
INTERVENTIONAL ONCOLOGY
Factors Associated with Tumor Progression After Percutaneous Ablation of Hepatocellular Carcinoma: Comparison Between Monopolar Radiofrequency and Microwaves. Results of a Propensity Score Matching Analysis Damien Bouda1 • Vincent Barrau1 • Lucas Raynaud1,2 • Marco Dioguardi Burgio1 Luisa Paulatto1 • Vincent Roche1 • Annie Sibert1,2,3 • Nadia Moussa1 • Vale´rie Vilgrain1,2,3 • Maxime Ronot1,2,3
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Received: 14 January 2020 / Accepted: 30 May 2020 Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2020
Abstract Purpose To identify risk factors for local and distant intrahepatic tumor progression after percutaneous ablation of HCC and to compare MWA with monopolar RFA. Materials and Methods Consecutive patients with early or very early HCC who underwent percutaneous monopolar RFA or MWA were included. Factors associated with local and distant tumor progression were identified. Propensity score matching (PSM) was used to limit bias. Statistical analyses were performed with the Kaplan–Meier method using the log-rank test and Cox regression models. Results One hundred ninety HCC (mean diameter 23 ± 8.6 mm) were treated by RFA (n = 90, 47%) or MWA (n = 100, 53%) in 152 patients (mean age 63 ± 11, 79% men) between 2009 and 2016. The technical success rate was 97.4% (n = 185 HCC). After a median follow-up of 24.6 months (IQR: 9.7–37.2), 43 (23%), HCC showed local tumor progression [after a median of 13.4 months (IQR: 5.8–24.3)] and 91 (63%) patients had distant intrahepatic tumor progression (after a median of 10.4 months (IQR: 5.7–22). The cox model after PSM identified
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00270-020-02549-8) contains supplementary material, which is available to authorized users. & Maxime Ronot [email protected] 1
Department of Radiology, Beaujon Hospital, APHP, University Hospitals Paris Nord Val de Seine, 100 Boulevard du Ge´ne´ral Leclerc, 92118 Clichy, Hauts-de-Seine, France
2
University Paris Diderot, Sorbonne Paris Cite´, Paris, France
3
INSERM U1149, Centre de Recherche biome´dicale BichatBeaujon, CRB3, Paris, France
treatment by RFA (HR, 2.89; P = 0.005), HCC size C 30 mm (HR, 3.12; P = 0.007) and vascular contact (HR, 3.43; P = 0.005) as risk factors for local progression. Factors associated with distant intrahepatic progression were HCC C 30 mm (HR, 1.94; P = 0.013), serum AFP [ 100 ng/mL (HR, 2.56; p = 0.002), and hepatitis B carrier (HR, 0.51; p = 0.047). Conclusion The rate of local HCC progression was lower after MWA than monopolar RFA, regardless of tumor size and vascular contact. The ablation technique did not influence the risk of distant intrahepatic tumor progression. Keywords Carcinoma Hepatocellular Propensity score Disease progression
Introduction Hepatocellular carcinoma (HCC) is a leading cause of cancer-related death worldwide [1], and its incidence and mortality
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