A multicenter case–controlled study on laparoscopic hepatectomy versus microwave ablation as first-line therapy for 3–5 cm hepatocellular carcinoma in patients aged 60 and older

Abstract

Background: There is currently a lack of convincing evidence for microwave ablation (MWA) and laparoscopic liver resection (LLR) for patients ≥60 years old with 3–5 cm hepatocellular carcinoma. Materials and methods: Patients were divided into three cohorts based on restricted cubic spline analysis: 60–64, 65–72, and ≥73 years. Propensity score matching (PSM) was performed to balance the baseline variables in a 1:1 ratio. Overall survival (OS) and disease-free survival (DFS) were assessed, followed by a comparison of complications, hospitalization, and cost. Results: Among 672 patients, the median age was 66 (IQR 62–71) years. After PSM, two groups of 210 patients each were selected. During the 36.0 (20.4–52.4) month follow-up period, the 1-year, 3-year, and 5-year OS rates in the MWA group were 97.6, 80.9, and 65.3% and 95.5, 78.7, and 60.4% in the LLR group (HR 0.98, P=0.900). The corresponding DFS rates were 78.6, 49.6, and 37.5% and 82.8, 67.8, and 52.9% (HR 1.52, P=0.007). The 60–64 age cohort involved 176 patients, with no a significant difference in OS between the MWA and LLR groups (HR 1.25, P=0.370), MWA was associated with a higher recurrence rate (HR 1.94, P=0.004). A total of 146 patients were matched in the 65–72 age cohort, with no significant differences in OS and DFS between the two groups (OS (HR 1.04, P=0.900), DFS (HR 1.56, P=0.110)). In 76 patients aged ≥73 years after PSM, MWA provided better OS for patients (HR 0.27, P=0.015), and there were no significant differences in DFS between the two groups (HR 1.41, P=0.380). Taken together, for patients older than 65 years, the recurrence rate of MWA was comparable with LLR. Safety analysis indicated that LLR was associated with more postoperative bleeding (P=0.032) and hypoproteinemia (P=0.024). Conclusions: MWA was comparable to LLR in patients aged 65 years and older. MWA could be an alternative for the oldest old or the ill patients who cannot afford LLR, while LLR is still the first option of treatments for early-stage 3–5 cm hepatocellular carcinoma in capable elderly’s.