Percutaneous thermal ablation-based locoregional treatment for hepatocellular carcinoma larger than 3 cm: a 10-year single-center retrospective study

To investigate the long-term efficacy of percutaneous thermal ablation (PTA)-based locoregional treatment of patients with hepatocellular carcinoma (HCC) bearing tumors > 3 cm. In this single-center, retrospective study of 359 HCC patients with 587 tumors (5.1 ± 0.021 cm) treated with PTA-based locoregional treatment between 2011 and 2021 was performed. Radiological response was evaluated per lesion on enhanced computed tomography imaging one month after ablation. Local tumor progression (LTP), regional recurrence (RR), disease-free survival (DFS) and overall survival (OS) rates were assessed per patient in follow-up, while a Cox hazards regression analysis was used to determine significant factors associated with OS and DFS. Therapeutic outcomes were assessed in a subgroup analysis of tumor size, number, and the patients’ age after propensity score matching. The mean ± SD follow up duration was 30.0 ± 22.1 months. Complete Response was achieved in 87.7% of lesions after treatment. LTP and RR were detected in 52.5% and 66.9% of patients, respectively. The 1-, 3-, and 5-year DFS rates were 43.8%, 23.8%, and 14.6%, respectively. The 1-, 3-, 5-, 7-, and 10-year OS rates were 81.3%, 47.0%, 20.7%, 16.7%, and 14.4%, respectively. According to the multivariate analysis, tumor number, cirrhosis and platelet were significant factors for OS (P < 0.05); while tumor number and size were associated with DFS. In the subgroup analysis, the cumulative OS rates at 1, 3, and 5 years were 80.1%, 39.5%, and 27.1% in the medium tumor group(3 cm ≤ diameter < 5 cm) and 66.7%, 37.1%, and 7.3%, respectively, in the large tumor group (diameter ≥ 5 cm, HR = 1.44, 95% CI: 1.0–2.1, P < 0.05). The cumulative RR rates at 1, 3, and 5 years were 62.8%, 84%, and 89.3%, respectively, in the multiple-lesion group and 45.0%, 66.9%, and 76.6%, respectively, in the single-lesion group (HR = 0.63, 95% CI: 0.46–0.86, P < 0.05). The 1-, 3-, and 5-year OS rates were 71.5%, 34.9%, and 16.6% in patients aged ≤ 50 years and 83%, 50.4%, and 30.2%, respectively, in patients aged > 50 years (P < 0.05). PTA-based locoregional therapy represents an alternative method for the treatment of HCC patients with medium/large tumors.