Effectiveness and safety of sequential transarterial chemoembolization and microwave ablation for subphrenic hepatocellular carcinoma: A comprehensive evaluation

Table 1 Inclusion and exclusion criteria

Inclusion criteria	Exclusion criteria
Age range 18-75 years	Age < 18 years or > 75 years
HCC diagnosis according to AASLD guideline	No pathology or image evidence
Child-Pugh grade A or B	Child-Pugh grade C
BCLC grades A and B	BCLC grade C
ECOG score ≤ 2	ECOG score > 2
Tumor number ≤ 2	Tumor number > 2
Tumor diameter ≤ 6 cm	Tumor diameter > 6 cm
The nonsubphrenic tumor diameter ≤ 2 cm	The nonsubphrenic tumor diameter > 2 cm
No intrahepatic vascular invasion	Intrahepatic vascular invasion
PLT > 40 × 109	PLT ≤ 40 × 109

AASLD: American Association for Liver Disease; BCLC: Barcelona Clinic Liver Cancer; ECOG: Eastern Cooperative Oncology Group; PLT: Platelet; HCC: Hepatocellular carcinoma.

Table 2 Baseline characteristics of study patients

Variables	Total, n = 49	Subphrenic HCC, n = 27	Nonsubphrenic HCC, n = 22	P value	Statistic
Sex				0.646	Fisher
Male	44 (89.8)	25 (92.6)	19 (86.4)
Female	5 (10.2)	2 (7.4)	3 (13.6)
Age in years	58.0 ± 9.3	58.7 ± 10.1	57.2 ± 8.4	0.595	0.287
Etiology				0.608	Fisher
HBV	41 (83.7)	24 (88.9)	17 (77.3)
HCV	5 (10.2)	2 (7.4)	3 (13.6)
Non-hepatitis virus	3 (6.1)	1 (3.7)	2 (9.1)
Child-Pugh class				0.388	Fisher
A	43 (87.8)	25 (92.6)	18 (81.8)
B	6 (12.2)	2 (7.4)	4 (18.2)
AFP				0.646	Fisher
< 200 ng/mL	44 (89.8)	25 (92.6)	19 (86.4)
≥ 200 ng/mL	5 (10.2)	2 (7.4)	3 (13.6)
PLT as 109/L	105.5 ± 70.9	119.1 ± 87.6	88.9 ± 38.3	0.139	2.264
Undergone hepatectomy				0.146	2.112
No	35 (71.4)	17 (63.0)	18 (81.8)
Yes	14 (28.6)	10 (37.0)	4 (18.2)
Amount of iodized oil in mL	4.4 ± 2.6	4.6 ± 3.1	4.2 ± 1.8	0.597	0.283
Amount of epirubicin in mg	26.9 ± 7.1	24.8 ± 8.0	29.5 ± 4.9	0.019	5.877
Tumor number				0.617	Fisher
Single	45 (91.8)	24 (88.9)	21 (95.5)
Multiple	4 (8.2)	3 (11.1)	1 (4.5)
Tumor size in cm	3.2 ± 1.2	3.4 ± 1.1	3.0 ± 1.2	0.255	1.327
Transpulmonary				< 0.001	19.958
No	25 (51.0)	6 (22.2)	19 (86.4)
Yes	24 (49.0)	21 (77.8)	3 (13.6)

Data are n (%) or mean ± SD. AFP: Alpha-fetoprotein; HBV: Hepatic B virus; HCV: Hepatic C virus; PLT: Platelet; HCC: Hepatocellular carcinoma.

Table 3 Univariate and multivariate analysis of local tumor progression using Cox regression model

Variable	Local tumor pregression
	Univariate analysis		Multivariate analysis
	HR (95%CI)	P value	HR (95%CI)	P value
Female sex	0 (0-Inf)	0.086	ND	ND
Age	1.02 (0.96-1.09)	0.487	ND	ND
Etiology		0.407	ND	ND
HCV	Reference		ND	ND
HBV	1.31 (0.17-10.11)		ND	ND
Non-viral	0 (0-Inf)		ND	ND
CP B	0.66 (0.08-5.08)	0.668	ND	ND
AFP ≥ 200 ng/mL	2.07 (0.45-9.46)	0.388	ND	ND
PLT	1.0031 (0.9966-1.0096)	0.381	ND	ND
Non-undergone hepatectomy	0.46 (0.10-2.08)	0.271	ND	ND
Amount of iodized oil in mL	1.34 (1.15-1.57)	0.001	1.52 (1.11-2.08)	0.009
Amount of epirubicin in mg	1.07 (0.96-1.19)	0.174	ND	ND
Tumor number of 2	3.23 (0.70-14.80)	0.186	13.22 (1.62-107.51)	0.016
Tumor size in cm	2.59 (1.48-4.52)	< 0.001	ND	ND
Transpulmanory: 1 vs 0	1.50 (0.48-4.72)	0.487	ND	ND
Nonsubphrenic vs subphrenic	1.29 (0.42-4.00)	0.661	ND	ND

AFP: Alpha-fetoprotein; CI: Confidence interval; CP: Child-Pugh classification; HBV: Hepatic B virus; HCV: Hepatic C virus; HR: Hazard ratio; ND: Not done; PLT: Platelet.