Patient Characteristics
A total of 72 patients with HCC ≤ 5.0 cm were included in the present study (GA-group, n = 34; LA-group, n = 38). There were no significant differences in age, gender, ECOG score, etiology, Child–Pugh classification, tumor location, and tumor diameter between the two types of anesthesia. Patients in the GA-group and in the LA-group, the mean energy of each tumor was 55.5 ± 5.6 wt and 50.7 ± 6.1 wt, respectively. The mean ablation duration of each patients in the procedure of GA-group and LA-group were 128.7 ± 40.3 and 90.8 ± 33.3, respectively, and the difference between the two groups was statistically significant (P = 0.012).
Safety and Complication
Postoperative pain, fever (with/without treatment) were the most common adverse events after treatment (Table 4). With four exceptions, all adverse events and complications were CTCAE grade 1 or 2 (mild symptoms, no or local/noninvasive intervention indicated), or interventional radiology society Grade A or B (no or nominal treatment, no consequences). Of the exceptions, The incidence of liver abscess, asymptomatic perihepatic fluid, pleural effusion and subcapsular hepatic hemorrhage under GA group were 1(3%), 1(3%), 2(6%) and 1(3%), respectively. Corresponding to the LA group complication rate were 2(5%), 1(3%), 1(3%) and 1(3%), respectively. Of note, there are no statistical differences between the two anesthesia methods. Secondly, patients with sub-hepatic hemorrhage need to undergo interventional embolization; patients with pleural effusion need to be treated with auxiliary thoracic drainage, and these complications will undoubtedly prolong the patient's hospital stay. None of the patients had life-threatening complications during or after treatment.
Table 4
Adverse events and complications
Categories
|
GA group (n = 34)
|
LA group (n = 38)
|
P
|
Grades
|
Adverse events
|
CTCAE
|
|
CTCAE
|
|
|
Fever, maximum 38°C, no treatment
|
Ⅰ
|
4(12)
|
Ⅰ
|
6(16)
|
0.740*
|
Fever, > 38°C,treatment
|
Ⅱ
|
22(65)
|
Ⅱ
|
25(66)
|
1.000*
|
Nausea or vomiting
|
Ⅱ
|
5(15)
|
Ⅱ
|
3(8)
|
0.463§
|
Mild pain, requiring nonopioid oral analgesic treatment
|
Ⅱ
|
17(50)
|
Ⅱ
|
13(34)
|
0.233*
|
Moderate pain, requiring opioid oral analgesic treatment
|
Ⅱ
|
10(29)
|
Ⅱ
|
9(24)
|
0.604*
|
Mild liver dysfunction, requiring conservative treatment
|
Ⅱ
|
12(35)
|
Ⅱ
|
9(24)
|
0.310*
|
complications
|
|
|
|
|
|
Liver abscess
|
Ⅲ
|
1(3)
|
Ⅲ
|
2(5)
|
1.000§
|
Asymptomatic perihepatic fluid
|
Ⅳ
|
1(3)
|
Ⅳ
|
1(3)
|
1.000§
|
pleural effusion
|
Ⅲ
|
2(6)
|
Ⅲ
|
1(3)
|
0.599§
|
Subcapsular liver hemorrhage
|
Ⅳ
|
1(3)
|
Ⅳ
|
1(3)
|
1.000§
|
National Cancer Institute Common Terminology Criteria for Adverse Event (CTCAE version 4.03) |
Society of Interventional Radiology (SIR) classification system for Complications. Data are numbers of events. Data in parentheses are percentages. |
Note—general anesthesia (GA) and local anesthesia (LA) .Data are numbers of events. Data in parentheses are percentages. *Pearson χ2 test was used. §Fisher exact test was used. |
Local Tumor Progression
Comparison of local tumor progression (LTP) after MWA under local anesthesia(LA) and general anesthesia(GA). The mean LTP was 33.434 months (95% CI: 31.133, 35.734) in GA versus 31.132 months (95% CI: 28.535, 33.730) in LA (p = 0.230, log-rank test). The 12-, 24-, and 36-month LTP rates in GA were 94.1%, 87.9% and 74.4%, respectively, and the 12-, 24-, and 36-month LTP rates in LA were 94.7%,84.2% and 62.1%, respectively (Fig. 3A). Comparison of different anesthesia methods on LTP of tumor in challenging locations. The mean LTP was 32.055 months (95% CI: 28.973, 35.138) in GA versus 26.551 months (95% CI: 22.049, 31.053) in LA (p = 0.180, log-rank test). The 12-, 24-, and 36-month LTP rates in GA were 100.0%, 76.0% and 48.4%, respectively, and the 12-, 24-, and 36-month LTP rates in LA were 88.9%,66.7% and 35.4%, respectively (Fig. 3B).
Factors Affecting Ltp
Univariate Cox proportional hazard regression indicated that using different anesthesia methods (GA and LA) were not associated with longer LTP( P = 0.237), while tumor location (challenging locations) and the number of lesions (2–3 lesions) were all related to shorter LTP ( P = 0.000 and P = 0.020, respectively). Additionally, Multivariate Cox regression further revealed that the tumor location (regular locations) and the number of lesions (single) can independently predict better LTP (both P < 0.005)(Table 5). More specifically, The mean LTP was 35.533 months (95% CI:34.903, 36.162) in regular locations versus 28.607 months (95% CI: 25.423, 31.792) in challenging locations (p = 0.000, log-rank test). The 12-, 24-, and 36-month LTP rates in tumor with regular locations were 100.0%, 100.0% and 91.6%, respectively, and the12-, 24-, and 36-month LTP rates in tumor with challenging locations were 88.6%,71.2% and 40.2%, respectively (Fig. 4A); The mean LTP was 33.111 months (95% CI: 31.147, 35.075) for procedures with a single lesion versus 30.424 months (95% CI: 26.992, 33.855) for procedures with 2–3 lesions (p = 0.015, log-rank test). The 12-, 24-, and 36-month LTP-free survival rates in patients with a single lesion were 97.9%, 87.0% and 77.8%, respectively, and the 12-, 24-, and 36-month LTP-free survival rates in patients with 2–3 lesions were 88.0%,84.0% and 47.6%, respectively(Fig. 4B).
Table 5
Parameters
|
LTP
|
|
P
|
LTP
|
|
P
|
HR
|
95%CI
|
HR
|
95%CI
|
|
|
Univariate Cox’s regression
|
|
|
Multivariate Cox’s regression
|
|
|
|
Lower
|
Higher
|
|
|
Lower
|
Higher
|
|
Age (> 60 vs ≤ 60)
|
0.811
|
0.330
|
1.989
|
0.647
|
.862
|
0.336
|
2.209
|
0.757
|
AFP (> 200 vs ≤ 200ng/mL)
|
1.422
|
0.614
|
3.295
|
0.411
|
2.230
|
0.912
|
5.450
|
0.079
|
Tumour diameter (3⩾,<5 vs < 3cm)
|
0.783
|
0.334
|
1.832
|
0.572
|
2.766
|
0.787
|
9.722
|
0.113
|
Tumour location (challenging locations vs regular locations)
|
35.832
|
10.530
|
3.095
|
0.000
|
27.843
|
5.718
|
135.571
|
0.000
|
Number of lesion (single VS 2–3 lesions)
|
2.712
|
1.169
|
6.294
|
0.020
|
4.615
|
1.571
|
13.556
|
0.005
|
Child–Pugh stage (A vs B)
|
1.456
|
0.629
|
3.373
|
0.380
|
1.668
|
0.539
|
5.156
|
0.375
|
Anesthesia(GA VS LA)
|
1.690
|
0.709
|
4.032
|
0.237
|
2.465
|
1.003
|
6.061
|
0.049
|
Note—general anesthesia (GA) and local anesthesia (LA) ; Challenging locations( Hepatic dome, Close to the heart/diaphragm/hepatic hilum) |