Abstract:

Objective

To explore the clinical efficacy and safety of microwave ablation （MWA）combined with synchronous transarterial chemoembolization （TACE） and targeted immunotherapy in unresectable liver cancer.

Methods

We conducted a retrospective analysis of patient records from January 2021 to September 2024， involving 17 patients with large hepatocellular carcinoma who received MWA combined with synchronous TACE and targeted and immunotherapeutic drugs in our hospital， with Child-Pugh class A or B liver function.The study involved performing MWA under CT guidance， immediately followed by TACE， and initiating a combination of targeted therapy and immunotherapy within one week post-procedure.The primary endpoints included Disease Control Rate （DCR）， Objective Response Rate （ORR）， Progression-Free Survival（PFS）， Overall Survival （OS）， and safety.Statistical analysis was conducted using the Kaplan-Meier method to construct survival curves， the Log-rank test to compare patient survival rates， and Cox regression for multivariate analysis.Efficacy and safety were evaluated during follow-up.

Results

This technique was successfully applied in all patients.Among the 17 patients， 3 cases （17.6%） achieved complete remission （CR）， 11 cases （64.7%）achieved partial remission （PR）， 1 case （5.8%） presented with stable disease （SD）， while 2 cases （11.8%） had progressive disease （PD）.The objective response rate （ORR）， calculated as the sum of complete response（CR） and partial response （PR）， reached 82.3%.The disease control rate （DCR） was 88.2%.Moreover， the median progression-free survival （PFS） was not reached.The median OS was not reached.The survival rates at 6 months， 12 months， and 24 months were 100%， 93.8%， and 66.8%， respectively.Among the 10 patients with BCLC stage C， the median overall survival （OS） was 20 months.There were no bleeding or other related complications.In the safety assessment during the treatment with targeted and immunotherapeutic drugs， the overall incidence of adverse events was 100.0%.Among them， 3 cases （17.6%） had grade 3 adverse events， and grade 1-3 adverse events could be relieved after symptomatic treatment.

Conclusion

MWA combined with synchronous TACE and targeted immunotherapy is safe and effective for the treatment of large hepatocellular carcinoma.This offers new approaches and options for the clinical treatment of large hepatocellular carcinoma，improving the prognosis for patients with large liver cancer.

Key words: Large liver cancer, Hepatic arterial chemoembolization (TACE), Microwave ablation(MWA), Targeted therapy, Immunotherapy