Stereotactic Microwave Ablation of Early-Stage Hepatocellular Carcinoma in Patients with Transjugular Intrahepatic Portosystemic Shunts: A Matched Case-Control Study.

PURPOSE: To assess safety and outcomes of stereotactic CT-guided microwave ablation (MWA) for hepatocellular carcinoma (HCC) in patients with transjugular intrahepatic portosystemic shunts (TIPS) versus a matched control group without TIPS.

MATERIALS AND

METHODS

Retrospective matched case-control study of cirrhotic patients with HCC treated with stereotactic CT-guided MWA. TIPS patients were matched 1:1 to controls using hierarchical matching based on Child-Pugh class, number of treated tumors, MELD score, tumor diameter, and ablation date. Primary endpoints were primary technique efficacy (PTE), local tumor progression (LTP), 30-day complications, and 30-day all-cause mortality. Secondary endpoints were 12-month Kaplan-Meier estimates for progression-free survival (PFS), hepatic decompensation-free survival (HDFS), and overall survival (OS), compared using log-rank tests.

RESULTS

46 patients (23 TIPS, 23 controls) with 62 index lesions were analyzed. PTE was achieved in 30/31 lesions (96.8%) in both groups. Among lesions with PTE, LTP occurred in 1/30 lesions (3.3%) in the TIPS group and 0/30 lesions (0%) in controls. Within 30 days, two major complications occurred in the TIPS group and one in the control group; no 30-day deaths occurred. Observed 12-month estimates did not differ significantly between groups for PFS (52.4% vs. 46.0%, p = 0.876), HDFS (71.8% vs. 76.9%, p = 0.519), or OS (91.1% vs. 90.0%, p = 0.903). Child-Pugh A was associated with higher HDFS than Child-Pugh B (95.8% vs. 50.2%, p = 0.001).

CONCLUSION

Stereotactic CT-guided MWA of early-stage HCC appears feasible in carefully selected patients with TIPS, warranting further evaluation in larger cohorts.

LEVEL OF EVIDENCE: 3b.