Supplementary Material for: Period-dependent survival benefit of percutaneous microwave ablation for hepatocellular carcinoma: 12-year real-world multicentric experience

Introduction: Although being a promising technique for hepatocellular carcinoma (HCC) treatment, the 10-year efficacies of microwave ablation (MWA) are unknown. Objective: To assess whether the advances of MWA for HCC translated into a real-world survival benefit. Methods: This retrospective study included 2,354 patients with Barcelona Clinic Liver Cancer (BCLC) stage 0 to B from 5 hospitals, with at least 2 years of follow-up for all the patients. Recurrence and survival were analyzed using the Kaplan-Meier method with time-period stratification. Results: A total of 5,326 HCCs (mean diameter, 2.9 cm ± 1.2) underwent 4051 sessions of MWA with a median follow-up of 61.3 (ranging 0.6–169.5) months during three time-periods of 2007–2010, 2011–2014, and 2015–2018.Technical success was achieved in 5,194 (97.5%) tumors with significant improvement over time, especially for > 3.0 cm HCC (p <0.001). LTP showed no period-dependent advance and > 3.0 cm HCC and perivascular location were the risk factors for LTP. The median intra-hepatic metastasis time was 27.6 (95% CI 25.2–28.8) months, with 5- and 10-year occurence rate of 68.8% and 79.4%, respectively. The 5- and 10-year overall survival were 63.9% and 41.1%, respectively, and BCLC stage 0, A, B patients all with an observable survival improvement over time(p<0.001). The median disease-free survival time increased from 19.4 (95% CI 16.5–22.6) months in 2007–2010 to 28.1 (95% CI 25.9–32.3) months in 2015–2018. The improved survival for early recurrent (≤ 2 years)patients was period- dependent as verified by Cox regression analyses. The major complications rate per procedure was 2.2% (88/4051). Conclusions: These real-world data show MWA provided anupward trend in survivalfor HCC patients with BCLC stage 0–B over a 12-year follow-up time. A clear survival benefit in early recurrent patients was also observed encouragingly.

引言：尽管微波消融（microwave ablation, MWA）是肝细胞癌（hepatocellular carcinoma, HCC）颇具前景的治疗手段，但其10年疗效仍未明确。
研究目的：旨在评估肝细胞癌微波消融技术的进展是否转化为真实世界中的生存获益。
研究方法：本回顾性研究纳入了来自5家医院的2354例巴塞罗那临床肝癌（Barcelona Clinic Liver Cancer, BCLC）分期0至B期患者，所有患者均完成至少2年的随访。采用按时间分层的Kaplan-Meier法分析复发与生存情况。
研究结果：本研究在2007-2010年、2011-2014年、2015-2018年三个时间阶段内，共纳入5326个肝细胞癌病灶（平均直径2.9 cm ±1.2），完成4051次微波消融治疗，中位随访时间为61.3个月（范围0.6~169.5个月）。病灶技术成功率达5194例（97.5%），且随时间推移显著提升，尤其针对直径＞3.0 cm的肝细胞癌病灶（p＜0.001）。局部肿瘤进展（Local Tumor Progression, LTP）未随时间呈现显著改善，病灶直径＞3.0 cm及血管旁位置是局部肿瘤进展的危险因素。肝内中位转移时间为27.6个月（95%CI 25.2~28.8），5年及10年发生率分别为68.8%和79.4%。患者5年及10年总体生存率分别为63.9%和41.1%，BCLC分期0、A、B期患者的总体生存率均随时间呈现显著提升（p＜0.001）。中位无病生存期从2007-2010年的19.4个月（95%CI 16.5~22.6）提升至2015-2018年的28.1个月（95%CI 25.9~32.3）。经Cox回归分析证实，早期复发（≤2年）患者的生存改善具有时间依赖性。单次治疗的主要并发症发生率为2.2%（88/4051）。
研究结论：本研究的真实世界数据显示，在长达12年的随访周期中，针对BCLC分期0~B期的肝细胞癌患者，微波消融治疗的生存获益呈持续上升趋势。令人鼓舞的是，早期复发患者也获得了明确的生存获益。