The HCC tumor load value predicts long-term results according to MWA

The radiological tumor loading score (TBS) seems to be a sensible predictor of long -term results in patients with Hepatocellular carcinoma (HCC) who meet the Milan criteria after microwave dilation (MWA), a new study.¹ The study published in the journal Cancerfound that a higher TBS score was associated with lower long-term survival rates.

The authors found that a surgical resection is considered the most effective treatment for HCC, alternative options such as MWA are necessary due to their superior security and precision and lower trauma in connection with the process. However, the results according to MWA vary considerably, and the existing models for predicting the reaction to MWA are not sufficient, she wrote.

A possible solution is a radiological TBS, a technology that was first reported in 2018 as a prognostic indicator for people with colorectal liver metastasis.² Since then, the tool has been used in a number of liver cancer applications, but it has not yet been rated as a predictor of the MWA forecast in HCC.¹

In order to determine their value in the HCC forecast, the authors pulled clinical data from 198 patients with HCC who met the Milan criteria between 2011 and 2018 and subjected MWA MWA. The researchers used X-Tile software to categorize patients in groups with low and high TBS. They then used the inclination assessment to compensate for covariates between the groups.

After comparing the focus of the inclination, the 5-year overall survival rate (OS) was 30.2% compared to 64.1% (P = 0.011) For the 95 low-tbs patients and the rate of recurrent survival (RFS), 21.9% in the High-TBS group, compared to 45.9% in the low-tbs group (P = .0059). The COX analysis indicated that high TBS and percutaneous MWA were independent risk factors for both OS and RFS. The middle RFS for patients in the high-tbs cohort were 45 months for patients who had undergone a laparoscopic MWA (20 cases) and 10.5 months for patients who have undergone percutaneous MWA (24 cases; P = .006).

“Our study resulted in a positive correlation between high TBS and increased local recurrence rates, combined with a decline in long -term survival rates,” said the researchers.

The authors quoted several reasons why laparoscopic MWA exceeded percutaneous. Under the reasons, they said that it enable the identification of small lesions and are carried out under general – more than local – anesthesia. The latter point ensures a better effect due to better cooperation in patients.

The authors cited a number of restrictions on their results. It was retrospectively in nature and included a relatively small sample size with a high TBS. They said that a wider study with several centers and more patients would enable more reliable validation of the TBS forecast model.

However, they said that the simplicity of TBS, which is based on ultrasound and can therefore also be carried out in relatively underperforming environments, is an attractive resource for clinical practice.

The authors came to the conclusion that their report suggests that a TBS limit of 3 serves as a meaningful prognostic instrument. However, they added that differences in patient populations and imaging techniques can influence the value of this cutoff and underline the need for additional study. In the meantime, clinicians should use TBS results together with other clinical factors to evaluate the correct treatment path for certain patients.

References

1. Liu X, Wang J, XU F, Chen J, Zhu M, Wang X. Predictation value of the radiological tumor load value for hepatocellular carcinoma within the Milanese criteria after microwave dilation: Effects on long -term results and treatment planning. Cancer med. 2025; 14 (9): E70806. DOI: 10.1002/Cam4.70806
2. Sasaki K., Morioka D., Conci S., et al. The tumor load value: a new “metro ticket” forecast tool for colorectal liver metastases based on tumor size and number of tumors. Ann Surg. 2018; 267 (1): 132-141. DOI: 10.1097/SLA.00000000002064