Trans-Arterial Chemoembolization Combined with Microwave Ablation versus Microwave Ablation Alone for 3–5 cm Hepatocellular Carcinoma: A Multicenter Retrospective Study

Objective: To compare safety and efficacy of transarterial chemoembolization (TACE) combined with microwave ablation (MWA) (TACE+MWA) versus only MWA treating hepatocellular carcinoma (HCC) 3– 5 cm. Methods: A retrospective analysis was conducted on data collected from 202 HCC patients who attended four hospitals between January 2014 and December 2017. Diagnosis of all lesions was based on histopathology and radiology. In total, 202 patients with HCC 3– 5 cm were included in this retrospective cohort study. These patients were classified into TACE+MWA and MWA groups based on the treatment. Patients were followed up with contrast enhanced CT or MRI. Images were evaluated and compared for treatment response and Adverse Events (AEs). Observe the occurrence of overall survival (OS), progression free survival (PFS) and AEs after the patient’s treatment. Survival analysis was performed using Kaplan-Meier method. Multivariate Cox proportional hazards regression analysis was performed to explore the relevant factors influencing the prognosis of patients. Results: A total of 202 patients (median age, 58 years; 178 male) were included, with 102 in the TACE+MWA group and 100 in the MWA group. Baseline characteristics were well balanced between the two groups. Complete response (CR) was achieved by 78.4% of patients who received combined therapy compared with 76% with only MWA. The median PFS was 49.2 months (95% CI: 45.4– 53.0) in the TACE+MWA group and 46.3 months (95% CI: 42.1– 50.5) in the MWA group, with no significant difference ( P =0.530). The median OS was significantly longer in the TACE+MWA group compared with the MWA group (81.7 months 95% CI: 78.2– 85.3 vs. 72.3 months 95% CI: 68.9– 75.7, P =0.013). The objective response rates (ORR) were comparable between the two groups (100.0% vs. 100.0%, P =1.000). The incidence of AEs was similar between the two groups, with no significant differences in major or minor complications. No treatment-related deaths were observed. Conclusion: TACE combined with MWA was associated with improved OS compared with MWA alone in patients with 3– 5 cm HCC, while maintaining a comparable safety profile. These findings suggest that combination therapy may be a promising treatment strategy, although further prospective studies are needed to confirm these results. Keywords: microwave ablation, transarterial chemoembolization, safety, hepatocellular carcinoma