Microwave ablation versus surgical resection for hepatocellular carcinoma within Milan criteria: A propensity score-based analysis.

OBJECTIVES

Microwave ablation (MWA) has emerged as an important local treatment option for patients with hepatocellular carcinoma (HCC) within the Milan criteria. This study aimed to compare the recurrence beyond the Milan criteria (RBM) rates between MWA and surgical resection (SR) in HCC patients.

METHODS

This retrospective multicenter study included 668 patients with Milan criteria HCC who underwent initial treatment with either MWA or SR between January 2010 and December 2023. Baseline characteristics were balanced using propensity score matching (PSM) and inverse probability of treatment weighting (IPTW). RBM, overall survival (OS), and recurrence-free survival (RFS) were compared between the two groups using the log-rank test.

RESULTS

A total of 668 patients (mean age, 60.1 ± 9.6 years; 532 male) were included. After PSM (n = 187 in each group), the 1-, 3-, and 5-year RBM rates were 26.5%, 40.9%, and 56.5% in the MWA group, and 18.1%, 42.7%, and 61.7% in the SR group, respectively (hazard ratio [HR] = 0.95, 95% confidence interval [CI] 0.70-1.29; P = 0.751). The corresponding OS rates were 92.9%, 81.0%, and 66.9% in the MWA group, and 95.1%, 85.6%, and 70.1% in the SR group (HR = 1.08, 95% CI 0.71-1.63; P = 0.727). The 1-, 3-, and 5-year RFS rates were 69.2%, 42.3%, and 27.8% in the MWA group, compared with 75.0%, 46.3%, and 27.3% in the SR group (HR = 1.08, 95% CI 0.83-1.39; P = 0.579). After IPTW adjustment, no significant differences were observed between the two groups in RBM (HR = 1.01, 95% CI 0.75-1.35; P = 0.969), OS (HR = 0.84, 95% CI 0.57-1.23; P = 0.372), or RFS (HR = 1.04, 95% CI 0.82-1.32; P = 0.733). In the PSM cohort, the MWA group had significantly fewer postoperative complications than the SR group (24.6% vs. 35.3%; P = 0.032) and a shorter length of hospital stay (median, 4 [IQR, 3-5.5] vs. 8 [IQR, 5-10] days; P < 0.001).

CONCLUSION

MWA demonstrated comparable RBM, OS, and RFS outcomes to SR in HCC patients within Milan criteria. Given its lower morbidity and shorter hospitalization, MWA represents an effective local treatment alternative in this patient population.