Percutaneous microwave ablation for viable hepatic cystic echinococcosis: Real-world outcomes from a multicenter study.

OBJECTIVES

Hepatic cystic echinococcosis (hepatic CE.) remains endemic in many regions, with severe complications and even death. Current treatments face limitations in efficacy and accessibility, while microwave ablation (MWA) represents a promising minimally invasive alternative, but real-world multicenter evidence is lacking.

METHODS

This retrospective multicenter study included patients with imaging-confirmed viable hepatic CE (WHO-IWGE CE1-CE3) who underwent ultrasound-guided aspiration-assisted percutaneous MWA at three tertiary hospitals in China between 2016 and 2024. Primary outcomes were local lesion progression (LLP) and recurrence-free survival (RFS). Secondary outcomes included technical success and safety. Predictors of recurrence were identified using Firth-penalized Cox regression. Four hierarchical risk models (Full, Extended, Basic, Mini) were developed and evaluated using Harrell's C-index and Kaplan-Meier analysis.

RESULTS

The study included 73 patients (56.2% female, mean age 51.4 ± 14.0 years) with 99 lesions. The mean lesion diameter was 7.5 ± 2.5 cm. MWA achieved 100% complete ablation with no major complications. During the median follow-up 34.0 months (IQR, 21.0-43.0), LLP occurred in 9.1% of lesions. The 1-, 2-, and 3-year RFS rates were 92.3%, 78.6%, and 64.2%, respectively. Three independent recurrence predictors were identified: age >55 years, cyst diameter ≥11 cm, and elevated bilirubin. Four hierarchical risk models were developed, with the Full model (8 predictors, C-index=0.928), followed by the Extended (6 predictors, C-index = 0.917), Basic (4 predictors, C-index = 0.859), and Mini (2 predictors, C-index = 0.788) models. All models stratified 3-year RFS (100% low-risk vs 51-59% high-risk, p < 0.001).

CONCLUSIONS

MWA is a safe and effective minimally invasive option for hepatic CE, particularly in resource-limited settings. The hierarchical risk models enable precision treatment selection, enhancing clinical outcomes.