Microwave ablation versus laparoscopic resection as first-line therapy for solitary 3–5 cm hepatocellular carcinoma

Objectives To compare the effectiveness of microwave ablation (MWA) and laparoscopic liver resection (LLR) on solitary 3–5cm HCC over time. Materials From 2008 to 2019, 1,289 patients from 12 hospitals were enrolled in this retrospective study. Diagnosis of all lesions were based on histopathology. Propensity score matching (PSM) was used to balance all baseline variables between the two groups in 2008–2019 (n =335 in each group) and 2014–2019 (n =257 in each group) cohorts, respectively. Results For cohort 2008–2019, during a median follow-up of 35.8 months, there were no differences in overall survival (OS) between MWA and LLR (Hazard ratio (HR): 0.88, 95% confidence interval (CI) 0.65–1.19, P =0.420), and MWA was inferior to LLR regarding disease-free survival (DFS) (HR 1.36, 95%CI (1.05–1.75), P =0.017). For cohort 2014–2019, there was comparable OS (HR 0.85, 95%CI (0.56–1.30), P =0.460) and approached statistical significance for DFS (HR 1.33, 95%CI (0.98–1.82), P =0.071) between MWA and LLR. Subgroup analyses showed comparable OS in 3.1–4.0cm HCCs (HR 0.88, 95%CI (0.53–1.47), P =0.630) and 4.1–5.0cm HCCs (HR 0.77, 95%CI (0.37–1.60), P =0.483) between two modalities. For both cohorts, MWA shared comparable major complications (both P >0.05), shorter hospitalization and lower cost to LLR (all P <0.001). Conclusions MWA might be a first-line alternative to LLR for solitary 3–5cm HCC in selected patients with technical advances, especially for patients unsuitable for LLR.