Enhancing Patient Outcomes through Microwave Ablation in Hepatic Malignant Tumors: Insights on Recurrence Factors

Enhancing Patient Outcomes through Microwave Ablation in Hepatic Malignant Tumors: Insights on Recurrence Factors | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Enhancing Patient Outcomes through Microwave Ablation in Hepatic Malignant Tumors: Insights on Recurrence Factors Jutian Shi, Yutian Jiang, Jinpeng Li, Hua Chen, Ning Cong This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4353630/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract The treatment of hepatic malignant tumors poses a significant global health challenge, often managed through percutaneous microwave ablation (MWA). Understanding the effectiveness of MWA and the factors influencing tumor recurrence is essential for improving patient outcomes. Methods: In this study, a cohort of 101 patients out of 249 with hepatic malignant tumors treated at the Shandong Cancer Hospital and Institute were analyzed. The study evaluated disease-free and overall survival rates at 1, 2, and 3 years post-MWA, exploring correlations between tumor recurrence and variables such as Child-Pugh B liver function classification and lesion count. Additionally, a meta-analysis was conducted to identify independent risk factors for recurrence following MWA treatment. Results: Disease-free survival rates of 80.2%, 72.3%, and 70.3% at 1, 2, and 3 years post-MWA were observed, alongside overall survival rates of 99%, 97%, and 96%. Noteworthy associations were found between tumor recurrence and Child-Pugh B classification, as well as the number of lesions. The meta-analysis further supported lesion count and Child-Pugh B classification as independent risk factors for recurrence post-MWA. Conclusion: Child-Pugh B classification and lesion count emerge as pivotal factors in predicting tumor recurrence post-MWA treatment for hepatic malignant tumors. These insights offer valuable guidance to clinicians in treatment decisions and post-treatment monitoring strategies, potentially leading to improved patient care and outcomes. Hepatic malignant tumors Percutaneous microwave ablation Tumor recurrence Child-Pugh B classification Lesion count. Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Introduction Liver cancer is a leading cause of cancer-related death worldwide, particularly in our country, where its incidence and mortality rates remain elevated [ 1 , 2 , 3 , 4 ]. Simultaneously, the initial symptoms of malignant liver tumors are frequently inconspicuous, leading to the late-stage diagnosis of most patients. Although traditional treatment methods such as surgery, radiation therapy, and chemotherapy can be effective in some cases, they still have several limitations, including high recurrence rates, severe side effects, and high mortality rates [ 5 , 6 , 7 , 8 ]. Hence, searching for a safe and effective treatment method has become a key research priority in hepatocellular carcinoma therapy. In recent years, percutaneous microwave ablation (MWA) has emerged as a promising alternative to traditional liver cancer treatments. Unlike surgery or radiation therapy, which can be invasive and carry significant side effects, MWA uses microwave energy for targeted tumor cell elimination. This approach not only achieves effective local ablation but also reduces the side effects often seen with conventional treatments [ 9 , 10 , 11 , 12 ]. MWA's minimally invasive nature and its ability to preserve healthy liver tissue make it particularly advantageous for patients who might not be suitable for more aggressive treatments. Moreover, microwave ablation surgery is a minimally invasive procedure that enables rapid recovery, rendering it an effective modality for treating malignant liver tumors [ 13 , 14 ]. However, despite achieving some success in clinical applications, there remain numerous uncertainties regarding microwave ablation technology's therapeutic effects and indications. The Child-Pugh grading system is frequently utilized to evaluate impaired liver function and is widely applied in diagnosing and treating liver diseases, including cirrhosis and hepatitis [ 15 , 16 , 17 , 18 ]. Researchers have recently discovered that the Child-Pugh scoring system is critical in predicting treatment response and prognosis of malignant liver tumors. In particular, in patients classified as Child-Pugh B, there is a strong correlation between tumor recurrence and survival rate. Hence, the Child-Pugh classification has emerged as a crucial framework for guiding treatment strategies in patients with malignant liver tumors. While there has been a gradual increase in research on percutaneous microwave ablation for malignant liver tumors in recent years, the majority of studies have been limited in scale and struggle to offer robust guidance for clinical practice [ 9 , 10 , 11 ]. Furthermore, the current research findings remain inconclusive regarding the influencing factors of microwave ablation therapy, such as Child-Pugh classification, lesion size, and the number of lesions. Therefore, this study aims to systematically investigate the efficacy and influencing factors of percutaneous microwave ablation in treating hepatic malignancies based on a large amount of clinical data from the First Affiliated Hospital of China Medical University. This study addresses the current research gap and presents novel clinical evidence on the use of microwave ablation for treating malignant liver tumors. Moreover, for the first time, we have identified Child-Pugh class B as an independent risk factor for tumor recurrence. This finding holds crucial guidance value for adjusting and optimizing clinical treatment strategies. It is expected to greatly enhance patients' quality of life and prognosis. Materials and Methods Clinical Ethics Statement Before conducting this study, we obtained approval from the Ethics Committee of China Medical University First Hospital. All participants were adequately informed about the study's objectives, treatment procedures, potential risks, and potential benefits. Every participant signed an informed consent form, thus guaranteeing their voluntary participation and the ability to withdraw from the study at any moment. The personal information of all patients is kept strictly confidential. The data collected for this study is solely used for research purposes, and proper measures have been implemented to safeguard patient privacy and data security. General Information A total of 249 patient cases who underwent percutaneous microwave ablation for malignant liver tumors were collected from January 2015 to April 2018 at the Interventional Ward of China Medical University First Hospital. Following the screening process, 101 cases (113 lesions) were selected as the study subjects. The survival status of patients was recorded through telephone follow-up and medical records up until October 2018, along with the occurrence of recurrence. This study included patients diagnosed with malignant liver tumors, confirmed by histopathology, imaging, or other standard diagnostic methods. The age range of 28 to 88 years was selected based on previous studies indicating this range as most indicative of liver tumor prevalence and response to treatment. Patients underwent percutaneous microwave ablation as the first-line treatment and had complete baseline data, including age, gender, hepatitis history, liver cirrhosis presence, Child-Pugh classification, lesion number and size, and tumor type. All participants agreed and were able to complete the follow-up. We excluded patients meeting the following criteria: those who had undergone previous treatment for hepatic malignancies, such as surgical resection, radiation therapy, or chemotherapy, before percutaneous microwave ablation; patients with other significant comorbidities that could impact survival or treatment outcomes, such as heart disease, chronic respiratory diseases, or other malignancies; patients with incomplete baseline or follow-up data; patients who deceased shortly after treatment due to non-treatment-related causes; and patients who refused to cooperate with follow-up or failed to comply with medical advice. The inclusion and exclusion criteria are designed to ensure the efficacy and consistency of the study, enabling a more accurate evaluation of the effectiveness of percutaneous microwave ablation in managing malignant liver tumors and its associated factors of influence. Refer to Fig. 1 for detailed information regarding the patient inclusion and exclusion process. Treatment Methods Preoperative patients undergo a comprehensive serological examination, an electrocardiogram, lung CT, and plain and enhanced CT or MR scans of the liver and gallbladder. Before the surgery, the surgeon conducts a personal evaluation to determine the guidance method, needle insertion path, and ablation range. The microwave ablation procedure was conducted using the KY-2000 therapy machine, operating at a frequency of 2450MHz with a 15G microwave ablation needle. The selection of ablation parameters was based on pre-operative assessments of tumor size and location, aiming for optimal ablation coverage. Before the surgery, the surgeon conducts a personal evaluation to determine the guidance method, needle insertion path, and ablation range. The patient is placed in a supine position; the surgical site is cleansed with sterile drapes. Despite local anesthesia being a common choice for microwave ablation, we opted for general anesthesia in all cases to ensure maximal patient comfort and immobility, which is crucial given the variability in tumor sizes and locations. The lesion is located using ultrasound or CT guidance, and an ablative needle is inserted into the lesion site. Once the position is accurately displayed, the microwave ablation device is activated to perform ablation. The ablation procedure was carried out until the predetermined time, and it was observed that microbubbles fully encapsulated the liver lesions before the conclusion of the procedure. During the needle extraction procedure, needle tract ablation was performed to minimize the risk of tumor cell seeding. We carefully monitored the extent of ablation to ensure adequate treatment of the tract without overextending to non-visible areas, particularly the Glisson's capsule, which is challenging to observe with current imaging technologies. Once the needle is removed, another scan checks for bleeding and verifies complete lesion ablation. The patient will be transferred to the Post-Anesthesia Care Unit (PACU) for postoperative recovery. Throughout the study, two or more researchers with relevant expertise in hepatology and oncology were involved in the literature screening, quality assessment, and data extraction process. This ensured the rigorousness and accuracy of the study design and outcomes. Therapeutic Efficacy Evaluation Following 4–6 weeks of skin microwave ablation treatment, patients undergo plain and contrast-enhanced CT or MR examinations to verify complete ablation. Complete ablation is confirmed if no enhancement is observed within the ablation zone. Subsequently, a follow-up examination should be performed every three months to determine any recurrence of the ablated liver lesions using enhanced CT or MR imaging. The criteria used to determine both the occurrence and type of recurrence in a patient, based on imaging data, are as follows: if new lesions are detected within or near the ablated area following complete ablation, it is classified as an in-situ recurrence; if this is not the case, it is classified as an ectopic recurrence. Enhanced CT or MR imaging will measure the ablation zone's maximum horizontal and vertical dimensions at our hospital 4–6 weeks after the surgery. Meta-analysis This meta-analysis aims to systematically investigate the relevant factors contributing to postoperative recurrence following percutaneous microwave ablation for malignant liver tumors. The main focus is on the postoperative recurrence rate. We selected articles focused on patients with hepatic malignant tumors treated with percutaneous microwave ablation based on specific inclusion criteria. These articles were specifically chosen for their ability to provide sufficient data on the relationship between the postoperative recurrence rate and potential factors that may influence it. We only included randomized controlled trials, cohort studies, or case-control studies in the study design. We excluded comments, expert opinions, case reports, non-systematic reviews, and studies with incomplete or low-quality data. To ensure the study's comprehensiveness, a comprehensive literature search was conducted across databases including PubMed, EMBASE, Cochrane Library, and CNKI, by at least two experienced researchers. Meta-analysis was performed using specialized software such as RevMan or Stata, and the heterogeneity among studies was assessed using the I² statistic. Keywords include "microwave ablation", "malignant liver tumor", and "recurrence". Every article in the study underwent a meticulous selection process, from which pertinent information such as author details, publication date, study design, patient characteristics, and primary outcomes were extracted. All the included studies underwent quality assessment using the Newcastle-Ottawa Scale. Based on the obtained scores, they were then classified as high, moderate, or low. During the data analysis stage, we chose either the fixed effects model or the random effects model for meta-analysis, depending on the heterogeneity among studies. We calculated the pooled risk ratio or odds ratio for each factor that was considered to be potentially associated with postoperative recurrence. The I² statistic is employed to evaluate heterogeneity between studies, while a sensitivity analysis was conducted to confirm the robustness of the results. To evaluate potential publication bias, we generated a funnel plot. Specialized meta-analysis software (RevMan, version 5.4) was used for all statistical analyses, considering a P value less than 0.05 as statistically significant [ 19 ]. Statistical Methods To perform a comprehensive and in-depth analysis of the data for this study, we employed the SPSS 24.0 software for statistical analysis. All continuous variables, including ablative power, duration, and ablative range, were reported as mean ± standard deviation. They were then compared using either an independent sample t-test or the Mann-Whitney U test, depending on the normality of data distribution. Categorical variables, such as recurrence and patient survival status, are depicted through frequencies and percentages. Differences between groups are assessed using chi-squared tests or Fisher's exact probability method. To identify factors associated with the recurrence of malignant liver tumors, we initially conducted a univariate analysis. Variables with p-values less than 0.1 in the univariate analysis were included in the multivariable logistic regression analysis to control for potential confounders and determine independent risk factors. The regression findings will be reported as odds ratios (OR) and their respective 95% confidence intervals (CI). To evaluate the survival status of the patients, we employed the Kaplan-Meier method to generate a survival curve. Subsequently, we utilized the log-rank test to compare the survival disparities among various groups. The Cox proportional hazards model is commonly employed for conducting multi-factor survival analysis. All hypothesis tests are two-tailed. In all analyses, a p-value of less than 0.05 is considered statistically significant. Results Characteristics of Cases and Follow-up Results Among the included 101 cases, there were 64 males and 37 females. The age ranged from 28 to 88 years, with a mean age of 61.3 ± 11.87 years. Among them were 47 cases of hepatitis B, 8 cases of hepatitis C, 46 cases of non-hepatitis, and 57 cases of liver cirrhosis. In the preoperative liver function assessment, 82 cases were classified as Child-Pugh A grade, while 19 were classified as B. There were 89 cases of single lesions, 12 cases of multiple lesions, 78 cases of lesions smaller than 3 centimeters, 18 cases of lesions ranging from 3 to 5 centimeters, and 5 cases of lesions larger than 5 centimeters. A total of 56 cases of primary malignant tumors and 45 cases of secondary malignant tumors were identified. Postoperative follow-up was carried out until October 2018, with a follow-up period ranging from 6 to 44 months. The average follow-up time was 26.45 ± 10.53 months. As of October 2018, there were 22 cases of recurrence, 79 cases of no recurrence, 97 cases of survival, and 4 cases of death. The disease-free survival rates at 1, 2, and 3 years after surgery were 80.2%, 72.3%, and 70.3%, respectively. Similarly, the overall survival rates at 1, 2, and 3 years after surgery were 99%, 97%, and 96%, respectively. Results of Single-factor Analysis During the follow-up observation of 101 patients, it was found that 22 patients experienced recurrence after undergoing microwave ablation treatment, while the remaining 79 patients were recurrence-free. In the recurrent cases, there were 15 males and 7 females. Out of the total, there were 12 cases with cirrhosis, 10 cases with a history of hepatitis, 10 cases with Grade A liver function, 12 cases with Grade B liver function, 15 cases with a single lesion, 7 cases with multiple lesions, and 21 cases with a diameter of ≤ 5 centimeters. Additionally, there were 11 cases of primary liver tumors and 11 cases of secondary liver tumors. A single-factor analysis was conducted on several variables. The results demonstrated a significant correlation between recurrence and the number of lesions in the Child-Pugh B stage (P 0.05). Please refer to Table 1 for specific results. Table 1 Univariate analysis of factors related to recurrence after percutaneous microwave ablation treatment for hepatic malignant tumors Factor Number of Cases Recurrence No Recurrence P-value Gender male 64 15 49 0.596 female 37 7 30 Age > 60 59 15 44 0.293 ≤ 60 42 7 35 cirrhosis Yes 57 12 45 0.84 No 44 10 34 History of hepatitis Yes 55 10 45 0.338 No 46 12 34 Child Pugh grading A 82 10 72 < 0.001 B 19 12 7 Number of lesions single 89 15 74 0.001 Multiple 12 7 5 Lesion size 5cm 5 1 4 0.146 Tumor type Primary 56 11 45 0.561 secondary 45 11 34 Multiple Factor Analysis Results A multifactorial analysis revealed a statistically significant correlation (P < 0.05) between Child-Pugh B status and the occurrence of postoperative recurrence in patients with recurrent malignant liver tumors treated with microwave ablation. However, no correlation was found between the number, size, and type of lesions and postoperative recurrence, and this lack of correlation was not statistically significant (P > 0.05). Please refer to Table 2 for detailed results. Table 2 Multivariate regression analysis of factors associated with recurrence after percutaneous microwave ablation treatment for hepatic malignant tumors Factor Regression Coefficient Standard Error Relative Risk P-value Tumor Type -1.315 0.703 0.268 0.061 Child Classification -2.86 0.768 0.057 < 0.001 Number of Lesions -1.492 0.803 0.225 0.063 Lesion Size -0.161 0.691 0.851 0.816 The Impact of Melting Parameters on the Range We screened the characteristics of 55 cases from the data, which included intraoperative parameters and complete postoperative imaging data at 1 month. It is important to note that all cases in the study had a single lesion. The majority of lesions have a maximum diameter of ≤ 3cm (which accounts for 96.3% of cases), whereas a minority of cases have a maximum diameter of ≤ 5cm. 3. Use the same model as the ablation needle. 4. All are single-electrode, single-point ablations. The analysis of ablation power and time reveals that, within a specific range, ablation's transverse and longitudinal diameters gradually increase with the increase in power and time. Statistical significance (P < 0.05) is observed when the ablation power is set at 60W for a duration of 6 minutes, as compared to 5 minutes. Similarly, when the ablation time is 6 minutes, statistical significance (P < 0.05) is observed between the ablation power of 60W and 55W or 50W. Please refer to Fig. 2 . A meta-analysis Provides Additional Confirmation of the Close Relationship Between the Number of Lesions and the Child-Pugh B Grade with the Recurrence of Liver Malignant Tumors in Patients who Undergo Percutaneous Microwave Ablation We conducted a thorough literature search across multiple databases, such as PubMed, EMBASE, Cochrane Library, and CNKI. Keywords include "microwave ablation", "malignant liver tumor", and "recurrence". A total of 1280 articles were retrieved. Duplicates, unrecorded data, comments, expert opinions, case reports, and non-systematic reviews were excluded based on the title. Additionally, articles focusing on combination therapy and liver diseases other than the selected condition were excluded, resulting in 75 articles. Each included article underwent a meticulous screening process to eliminate those lacking statistical recurrence data or reported recurrence without conducting multiple-factor regression analysis. Eventually, 10 retrospective studies were included in the meta-analysis (Fig. 3 ). Relevant information about the author, publication date, study design, patient characteristics, and key findings were extracted from the article (Table 3 ). Table 3 Incorporate basic characteristics of literature. Authors Year Country Child–Pugh B Multiple nodule P-value HR 95% CI P-value HR 95% CI Tomoki Ryu PMID: 34618325 2022 Japan 0.013 1.44 1.080–1.890 < 0.001 1.51 1.22–1.87 Kanehiko Suwa PMID: 33675382 2021 Japan 0.708 1.09 0.696–1.706 0.051 1.149 0.999–1.321 Tianqiang Jin PMID: 32781862 2020 China 0.66 1.215 0.511–2.890 < 0.004 2.825 1.401–5.695 Yun Xu PMID: 27649577 2017 China 0.023 2.657 1.001–7.052 Tao Wang PMID: 27620527 2016 China 0.98 0.515–1.866 Chenwei Wang PMID:32449005 2020 China 0.002 1.68 1.05–2.68 Zhiwei Chen CNKI 2021 China 0.203 1.481 0.809–2.714 < 0.001 2.547 1.532–4.237 Yuan Lv CNKI 2020 China 0.36 2.56 0.350–18.970 0.17 1.55 0.83ཞ2.90 Fan Xie CNKI 2022 China < 0.001 2.998 1.858–4.836 Tomoki Ryu PMID: 31359277 2019 Japan < 0.001 1.64 1.29–2.08 Note: HR: Hazard Ratio; CI: Confidence Interval Firstly, we aim to analyze the correlation between Child-Pugh B classification and recurrence rates following percutaneous microwave ablation. Upon conducting a preliminary statistical synthesis of the data from the included studies, the I2 test revealed an absence of significant heterogeneity among the groups (I2 = 0%, p = 0.64). Additionally, the funnel plot demonstrated the absence of publication bias (Fig. 4 A-B). A fixed-effects model was used for analysis, yielding a pooled hazard ratio (HR) of 1.39 with a 95% confidence interval (CI) of [1.13, 1.72]. The p-value of less than 0.01 suggests a statistically significant increase in the risk of recurrence among patients with Child-Pugh B who underwent percutaneous microwave ablation therapy (Fig. 4 C). Subsequently, we examined the association between the number of lesions and recurrence following percutaneous microwave ablation. Our analysis revealed considerable heterogeneity among the studies (I² > 50%, p < 0.01) (Fig. 5 A-B). Thus, we selected the random-effects model for meta-analysis to consider the possible variations among studies. Using random effects models, the analysis revealed a pooled hazard ratio (HR) of 1.69, with a 95% confidence interval (CI) of [1.33, 2.13] and a p-value of less than 0.01, indicating a statistically significant difference (Fig. 5 C). These findings suggest that patients with multiple lesions have a significantly higher risk of postoperative recurrence than those with a single lesion. In particular, patients with multiple lesions have a significantly higher risk of postoperative recurrence when compared to those with a single lesion. These findings are in line with previous outcomes reported by single-center studies. However, the larger sample size and higher statistical power of the meta-analysis enhance the stability and reliability of these findings. In conclusion, our meta-analysis solidifies the strong association between tumor number and Child-Pugh B class and the recurrence of malignant liver tumors following percutaneous microwave ablation. This study offers precise guidance for clinical doctors, enabling them to assess postoperative recurrence risk accurately and develop tailored follow-up strategies for high-risk patients. Discussion Percutaneous microwave ablation has emerged as a significant approach for managing malignant liver tumors [20, 21, 22, 23]. This study's finding of a 70.3% 3-year disease-free survival rate post-percutaneous microwave ablation highlights a significant improvement over previous research. This higher survival rate may stem from our innovative research methods and clinical practice. It underscores the potential of MWA as a more effective treatment option compared to traditional methods like surgery or chemotherapy. It could be attributed to our research methods, topics, and clinical practice. However, this proportion also serves as a reminder that nearly one-third of patients will experience relapse after undergoing treatment. This study identified Child-Pugh B class as an independent risk factor for the recurrence of malignant liver tumors. The Child-Pugh classification is a significant indicator reflecting liver function and is directly associated with the post-treatment recovery and the recurrence rate [16, 17, 24]. Our findings are consistent with previous literature reports, confirming the importance of predicting recurrence. It also implies that clinical doctors must accurately evaluate the Child-Pugh classification of patients before treatment to guide the treatment strategy. Furthermore, apart from classifying patients as Child-Pugh B, this study also examined additional potential factors that could influence the recurrence of the condition. However, there is no significant correlation between the number of lesions, the size, and the type of tumor recurrence. This finding diverges from certain reports found in the existing literature, with the divergence possibly stemming from factors like sample selection and regional disparities. However, this result offers a fresh perspective for future research. In conclusion, we have determined that the number of lesions and Child-Pugh B classification positively correlate with postoperative recurrence. Child B stage is an independent risk factor for recurrence in the microwave ablation treatment of malignant liver tumors. The ablation horizontal and vertical diameters gradually increase within a specific range as the ablation power and time increase. Furthermore, noteworthy distinctions can be observed among the horizontal and vertical diameters generated by varying ablation power or time (Figure 6). In this study, both the power and duration of ablation were found to impact the range of ablation significantly. As the power and time of ablation increase, the range of ablation gradually expands. A notable difference exists in the effect produced by ablating for 5 and 6 minutes, particularly when employing a power of 60W. This study provides valuable information for clinical practice, highlighting the significance of selecting suitable ablation parameters to enhance treatment efficacy. Based on the findings above, evaluating the Child-Pugh classification of the patient is recommended before conducting percutaneous microwave ablation therapy. Subsequently, suitable treatment strategies should be selected. Simultaneously, selecting the suitable ablation power and duration is pivotal for enhancing the therapeutic effectiveness. Physicians should adapt the ablation parameters according to the patient's specific conditions, taking into account factors such as the size and location of the lesion. Our research demonstrates a comparatively higher 3-year disease-free survival rate than other related studies. However, there are disparities in the factors that influence recurrence. It could be attributed to various factors, including research methods, patient selection, and geographical considerations. However, diverse research findings offer a more comprehensive perspective, enhancing our understanding of treating liver malignancies. Although our findings are promising, it's important to acknowledge the study's limitations, such as potential selection bias due to the single-hospital sample. Future studies should aim for a broader, multicenter approach to confirm and expand upon these results, offering a more comprehensive understanding of MWA's efficacy. Secondly, certain potential influencing factors may not have been accounted for. In the future, we aim to perform larger sample and multicenter studies to further validate and expand upon the findings of this research. In summary, this study confirmed the efficacy of percutaneous microwave ablation for treating malignant liver tumors. Additionally, it identified Child-Pugh B grade as a significant and independent risk factor for tumor recurrence. This study provides important guidance for clinical treatment. Moreover, our research has uncovered the impact of ablation power and duration on therapeutic effectiveness, which offers valuable insights for clinical applications. Despite its limitations, this study should not be overlooked due to its scientific and clinical value, which includes providing strong references and guidance for future research and clinical practice. Declarations Availability of data All the data is available Acknowledgment None. Funding This study was funded by the General Program of the National Natural Science Foundation of China (No. 82372070). Conflict of Interest The author declares no conflict of interest. Authors ’ contributions Ning Cong and Hua Chen played crucial roles in research design and data collection, while Jinpeng Li and Yutian Jiang were involved in data analysis and result interpretation. Jutian Shi conducted literature review and meta-analysis, providing further support and evidence for the study. The collaboration of these authors made it possible to evaluate the therapeutic efficacy of MWA in treating hepatic malignant tumors and identifying factors related to recurrence, offering valuable reference information for clinicians in treatment decisions and follow-up procedures. Ethics approval and consent to participate The study was conducted in accordance with ethical principles and was approved by the Ethics Committee of the Shandong Cancer Hospital and Institute, Shandong Province.(No.201801024) All patients provided informed consent to participate in the study before undergoing percutaneous microwave ablation (MWA) treatment for hepatic malignant tumors. The research followed established ethical guidelines to ensure patient confidentiality, data integrity, and respect for individual rights. Participation in the study was voluntary, and patients were informed about the nature of the research, potential risks and benefits, and their right to withdraw at any time without any impact on their medical care. The study adhered to ethical standards to safeguard the well-being and rights of the participants involved. 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Ryoikibetsu shokogun shirizu ,7 (1995): 151-4. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4353630","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":299530034,"identity":"bf842b73-cbde-4f6a-bab1-7394d1d34f11","order_by":0,"name":"Jutian Shi","email":"","orcid":"","institution":"Shandong Cancer Hospital and Institute, Shandong First Medical University, Shandong Academy of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Jutian","middleName":"","lastName":"Shi","suffix":""},{"id":299530040,"identity":"f2c7882e-002e-41dc-920c-08197f9c2c73","order_by":1,"name":"Yutian Jiang","email":"","orcid":"","institution":"Yan Tai Yu Huangding Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yutian","middleName":"","lastName":"Jiang","suffix":""},{"id":299530044,"identity":"0883f8e5-1a13-4cd6-b4d5-ba9a5443e6dd","order_by":2,"name":"Jinpeng Li","email":"","orcid":"","institution":"Shandong Cancer Hospital and Institute, Shandong First Medical University, Shandong Academy of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Jinpeng","middleName":"","lastName":"Li","suffix":""},{"id":299530047,"identity":"fbe4d98d-126f-4efd-89f6-e5987b477406","order_by":3,"name":"Hua Chen","email":"","orcid":"","institution":"Shandong Cancer Hospital and Institute, Shandong First Medical University, Shandong Academy of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Hua","middleName":"","lastName":"Chen","suffix":""},{"id":299530050,"identity":"65e597d4-8d20-490a-97a4-45dc45355c7d","order_by":4,"name":"Ning Cong","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA3klEQVRIie3PsQrCMBCA4ZODuESzRhR9hYLgJPgqCYVOCo4dBANKO4g4+xaOjimBTBFXR30DxcXBQZ0VUzeHfPP93B1AEPwhwmZayztHhlgcRTrxJ3Vupb6ofrWRkzg6OutP2jDsFmuVsGhPe43THEscBjoyta1pgiFJKhUBli/E9wSVMDVnupUZ2oPctoC73ca3RRtKTIxIkoN0BCI+8iVSvZJphrQ3lhmWSWIo1lmC9JlAuYRb0GfXR44k5sJZ6v2ls1pdzyLlONib4nJLJ22WL78nb+hv40EQBMFHD7MSS8wlCOHGAAAAAElFTkSuQmCC","orcid":"","institution":"Shandong Cancer Hospital and Institute, Shandong First Medical University, Shandong Academy of Medical Sciences","correspondingAuthor":true,"prefix":"","firstName":"Ning","middleName":"","lastName":"Cong","suffix":""}],"badges":[],"createdAt":"2024-05-01 10:06:02","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4353630/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4353630/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":56276785,"identity":"28ea5e1c-5d4f-43d8-b868-100968aa0ff5","added_by":"auto","created_at":"2024-05-10 20:11:46","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":200557,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFlowchart depicting the process of inclusion and exclusion of study subjects.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4353630/v1/d47236c7762d61157852090e.jpg"},{"id":56276952,"identity":"7fc456cb-ec93-4471-9eaa-539e7daf1d9d","added_by":"auto","created_at":"2024-05-10 20:12:26","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":1597142,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eComparison of the microwave ablation range for malignant liver tumors at different times and powers.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNote: (A) Relationship between the average ablation width for 5 minutes and 6 minutes at constant powers of 50W, 55W, and 60W. (B) Relationship between the average ablation length for 5 and 6 minutes at constant powers of 50W, 55W, and 60W. (C) Relationship between the average ablation width at 50W, 55W, and 60W for a constant ablation time of 5 and 6 minutes. (D) Relationship between the average ablation length at 50W, 55W, and 60W for a constant ablation time of 5 minutes and 6 minutes.\u003c/p\u003e","description":"","filename":"Figure2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4353630/v1/8b38bbd450241bdddffcb626.jpg"},{"id":56276783,"identity":"19c3fc64-2e05-46de-af83-3cf92f584ebb","added_by":"auto","created_at":"2024-05-10 20:11:42","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":1287898,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFlowchart illustrating the process of literature retrieval and selection for the meta-analysis.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Figure3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4353630/v1/4efb3a40bd0fd2d5bd0f227c.jpg"},{"id":56276834,"identity":"84926b05-c084-44dc-86f4-b36e5f21dba0","added_by":"auto","created_at":"2024-05-10 20:12:15","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":947569,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eResults of the meta-analysis on the association between microwave ablation for malignant liver tumors in patients and recurrence rate about Child-Pugh B classification.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNote: (A) Forest plot for the meta-analysis of clinical studies on the association between microwave ablation for malignant liver tumors in patients and recurrence rate about Child-Pugh B classification. (B) Funnel plot. (C) Sensitivity analysis.\u003c/p\u003e","description":"","filename":"Figure4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4353630/v1/bea90abbd767ce0161419a9c.jpg"},{"id":56276737,"identity":"abe6e0fd-6c4b-4b69-8720-0044587eb19c","added_by":"auto","created_at":"2024-05-10 20:11:25","extension":"jpg","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":1210874,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eResults of the meta-analysis on the association between microwave ablation for malignant liver tumors in patients and several tumors.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNote: (A) Forest plot for the meta-analysis of clinical studies on the association between microwave ablation for malignant liver tumors in patients and several tumors. (B) Funnel plot. (C) Sensitivity analysis.\u003c/p\u003e","description":"","filename":"Figure5.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4353630/v1/bdd73ddc8aaa5e4989963b12.jpg"},{"id":56276835,"identity":"62121254-5b91-4588-ba3a-39317dc8342f","added_by":"auto","created_at":"2024-05-10 20:12:16","extension":"jpg","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":1037304,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eDiagram illustrating the factors influencing the efficacy of microwave ablation for malignant liver tumors through percutaneous treatment.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Figure6.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4353630/v1/1abb5e16cd37f91189002f78.jpg"},{"id":56348205,"identity":"c4a4cfd5-1bd8-49be-a4f3-c2cb127cd61e","added_by":"auto","created_at":"2024-05-13 03:03:48","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":7011732,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4353630/v1/bed3d427-2ded-445a-923d-f94edcc0a7fb.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Enhancing Patient Outcomes through Microwave Ablation in Hepatic Malignant Tumors: Insights on Recurrence Factors","fulltext":[{"header":"Introduction","content":"\u003cp\u003eLiver cancer is a leading cause of cancer-related death worldwide, particularly in our country, where its incidence and mortality rates remain elevated [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Simultaneously, the initial symptoms of malignant liver tumors are frequently inconspicuous, leading to the late-stage diagnosis of most patients. Although traditional treatment methods such as surgery, radiation therapy, and chemotherapy can be effective in some cases, they still have several limitations, including high recurrence rates, severe side effects, and high mortality rates [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Hence, searching for a safe and effective treatment method has become a key research priority in hepatocellular carcinoma therapy. In recent years, percutaneous microwave ablation (MWA) has emerged as a promising alternative to traditional liver cancer treatments. Unlike surgery or radiation therapy, which can be invasive and carry significant side effects, MWA uses microwave energy for targeted tumor cell elimination. This approach not only achieves effective local ablation but also reduces the side effects often seen with conventional treatments [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. MWA's minimally invasive nature and its ability to preserve healthy liver tissue make it particularly advantageous for patients who might not be suitable for more aggressive treatments. Moreover, microwave ablation surgery is a minimally invasive procedure that enables rapid recovery, rendering it an effective modality for treating malignant liver tumors [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. However, despite achieving some success in clinical applications, there remain numerous uncertainties regarding microwave ablation technology's therapeutic effects and indications.\u003c/p\u003e \u003cp\u003eThe Child-Pugh grading system is frequently utilized to evaluate impaired liver function and is widely applied in diagnosing and treating liver diseases, including cirrhosis and hepatitis [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Researchers have recently discovered that the Child-Pugh scoring system is critical in predicting treatment response and prognosis of malignant liver tumors. In particular, in patients classified as Child-Pugh B, there is a strong correlation between tumor recurrence and survival rate. Hence, the Child-Pugh classification has emerged as a crucial framework for guiding treatment strategies in patients with malignant liver tumors. While there has been a gradual increase in research on percutaneous microwave ablation for malignant liver tumors in recent years, the majority of studies have been limited in scale and struggle to offer robust guidance for clinical practice [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Furthermore, the current research findings remain inconclusive regarding the influencing factors of microwave ablation therapy, such as Child-Pugh classification, lesion size, and the number of lesions.\u003c/p\u003e \u003cp\u003eTherefore, this study aims to systematically investigate the efficacy and influencing factors of percutaneous microwave ablation in treating hepatic malignancies based on a large amount of clinical data from the First Affiliated Hospital of China Medical University. This study addresses the current research gap and presents novel clinical evidence on the use of microwave ablation for treating malignant liver tumors. Moreover, for the first time, we have identified Child-Pugh class B as an independent risk factor for tumor recurrence. This finding holds crucial guidance value for adjusting and optimizing clinical treatment strategies. It is expected to greatly enhance patients' quality of life and prognosis.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eClinical Ethics Statement\u003c/h2\u003e \u003cp\u003e Before conducting this study, we obtained approval from the Ethics Committee of China Medical University First Hospital. All participants were adequately informed about the study's objectives, treatment procedures, potential risks, and potential benefits. Every participant signed an informed consent form, thus guaranteeing their voluntary participation and the ability to withdraw from the study at any moment. The personal information of all patients is kept strictly confidential. The data collected for this study is solely used for research purposes, and proper measures have been implemented to safeguard patient privacy and data security.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eGeneral Information\u003c/h2\u003e \u003cp\u003eA total of 249 patient cases who underwent percutaneous microwave ablation for malignant liver tumors were collected from January 2015 to April 2018 at the Interventional Ward of China Medical University First Hospital. Following the screening process, 101 cases (113 lesions) were selected as the study subjects. The survival status of patients was recorded through telephone follow-up and medical records up until October 2018, along with the occurrence of recurrence.\u003c/p\u003e \u003cp\u003eThis study included patients diagnosed with malignant liver tumors, confirmed by histopathology, imaging, or other standard diagnostic methods. The age range of 28 to 88 years was selected based on previous studies indicating this range as most indicative of liver tumor prevalence and response to treatment. Patients underwent percutaneous microwave ablation as the first-line treatment and had complete baseline data, including age, gender, hepatitis history, liver cirrhosis presence, Child-Pugh classification, lesion number and size, and tumor type. All participants agreed and were able to complete the follow-up. We excluded patients meeting the following criteria: those who had undergone previous treatment for hepatic malignancies, such as surgical resection, radiation therapy, or chemotherapy, before percutaneous microwave ablation; patients with other significant comorbidities that could impact survival or treatment outcomes, such as heart disease, chronic respiratory diseases, or other malignancies; patients with incomplete baseline or follow-up data; patients who deceased shortly after treatment due to non-treatment-related causes; and patients who refused to cooperate with follow-up or failed to comply with medical advice. The inclusion and exclusion criteria are designed to ensure the efficacy and consistency of the study, enabling a more accurate evaluation of the effectiveness of percutaneous microwave ablation in managing malignant liver tumors and its associated factors of influence. Refer to Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e for detailed information regarding the patient inclusion and exclusion process.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eTreatment Methods\u003c/h2\u003e \u003cp\u003ePreoperative patients undergo a comprehensive serological examination, an electrocardiogram, lung CT, and plain and enhanced CT or MR scans of the liver and gallbladder. Before the surgery, the surgeon conducts a personal evaluation to determine the guidance method, needle insertion path, and ablation range. The microwave ablation procedure was conducted using the KY-2000 therapy machine, operating at a frequency of 2450MHz with a 15G microwave ablation needle. The selection of ablation parameters was based on pre-operative assessments of tumor size and location, aiming for optimal ablation coverage. Before the surgery, the surgeon conducts a personal evaluation to determine the guidance method, needle insertion path, and ablation range. The patient is placed in a supine position; the surgical site is cleansed with sterile drapes. Despite local anesthesia being a common choice for microwave ablation, we opted for general anesthesia in all cases to ensure maximal patient comfort and immobility, which is crucial given the variability in tumor sizes and locations. The lesion is located using ultrasound or CT guidance, and an ablative needle is inserted into the lesion site. Once the position is accurately displayed, the microwave ablation device is activated to perform ablation. The ablation procedure was carried out until the predetermined time, and it was observed that microbubbles fully encapsulated the liver lesions before the conclusion of the procedure. During the needle extraction procedure, needle tract ablation was performed to minimize the risk of tumor cell seeding. We carefully monitored the extent of ablation to ensure adequate treatment of the tract without overextending to non-visible areas, particularly the Glisson's capsule, which is challenging to observe with current imaging technologies. Once the needle is removed, another scan checks for bleeding and verifies complete lesion ablation. The patient will be transferred to the Post-Anesthesia Care Unit (PACU) for postoperative recovery. Throughout the study, two or more researchers with relevant expertise in hepatology and oncology were involved in the literature screening, quality assessment, and data extraction process. This ensured the rigorousness and accuracy of the study design and outcomes.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eTherapeutic Efficacy Evaluation\u003c/h2\u003e \u003cp\u003eFollowing 4\u0026ndash;6 weeks of skin microwave ablation treatment, patients undergo plain and contrast-enhanced CT or MR examinations to verify complete ablation. Complete ablation is confirmed if no enhancement is observed within the ablation zone. Subsequently, a follow-up examination should be performed every three months to determine any recurrence of the ablated liver lesions using enhanced CT or MR imaging. The criteria used to determine both the occurrence and type of recurrence in a patient, based on imaging data, are as follows: if new lesions are detected within or near the ablated area following complete ablation, it is classified as an in-situ recurrence; if this is not the case, it is classified as an ectopic recurrence. Enhanced CT or MR imaging will measure the ablation zone's maximum horizontal and vertical dimensions at our hospital 4\u0026ndash;6 weeks after the surgery.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eMeta-analysis\u003c/h2\u003e \u003cp\u003eThis meta-analysis aims to systematically investigate the relevant factors contributing to postoperative recurrence following percutaneous microwave ablation for malignant liver tumors. The main focus is on the postoperative recurrence rate. We selected articles focused on patients with hepatic malignant tumors treated with percutaneous microwave ablation based on specific inclusion criteria. These articles were specifically chosen for their ability to provide sufficient data on the relationship between the postoperative recurrence rate and potential factors that may influence it. We only included randomized controlled trials, cohort studies, or case-control studies in the study design. We excluded comments, expert opinions, case reports, non-systematic reviews, and studies with incomplete or low-quality data.\u003c/p\u003e \u003cp\u003eTo ensure the study's comprehensiveness, a comprehensive literature search was conducted across databases including PubMed, EMBASE, Cochrane Library, and CNKI, by at least two experienced researchers. Meta-analysis was performed using specialized software such as RevMan or Stata, and the heterogeneity among studies was assessed using the I\u0026sup2; statistic. Keywords include \"microwave ablation\", \"malignant liver tumor\", and \"recurrence\". Every article in the study underwent a meticulous selection process, from which pertinent information such as author details, publication date, study design, patient characteristics, and primary outcomes were extracted. All the included studies underwent quality assessment using the Newcastle-Ottawa Scale. Based on the obtained scores, they were then classified as high, moderate, or low.\u003c/p\u003e \u003cp\u003eDuring the data analysis stage, we chose either the fixed effects model or the random effects model for meta-analysis, depending on the heterogeneity among studies. We calculated the pooled risk ratio or odds ratio for each factor that was considered to be potentially associated with postoperative recurrence. The I\u0026sup2; statistic is employed to evaluate heterogeneity between studies, while a sensitivity analysis was conducted to confirm the robustness of the results. To evaluate potential publication bias, we generated a funnel plot. Specialized meta-analysis software (RevMan, version 5.4) was used for all statistical analyses, considering a P value less than 0.05 as statistically significant [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Methods\u003c/h2\u003e \u003cp\u003eTo perform a comprehensive and in-depth analysis of the data for this study, we employed the SPSS 24.0 software for statistical analysis. All continuous variables, including ablative power, duration, and ablative range, were reported as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation. They were then compared using either an independent sample t-test or the Mann-Whitney U test, depending on the normality of data distribution. Categorical variables, such as recurrence and patient survival status, are depicted through frequencies and percentages. Differences between groups are assessed using chi-squared tests or Fisher's exact probability method. To identify factors associated with the recurrence of malignant liver tumors, we initially conducted a univariate analysis. Variables with p-values less than 0.1 in the univariate analysis were included in the multivariable logistic regression analysis to control for potential confounders and determine independent risk factors. The regression findings will be reported as odds ratios (OR) and their respective 95% confidence intervals (CI). To evaluate the survival status of the patients, we employed the Kaplan-Meier method to generate a survival curve. Subsequently, we utilized the log-rank test to compare the survival disparities among various groups. The Cox proportional hazards model is commonly employed for conducting multi-factor survival analysis. All hypothesis tests are two-tailed. In all analyses, a p-value of less than 0.05 is considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eCharacteristics of Cases and Follow-up Results\u003c/h2\u003e \u003cp\u003eAmong the included 101 cases, there were 64 males and 37 females. The age ranged from 28 to 88 years, with a mean age of 61.3\u0026thinsp;\u0026plusmn;\u0026thinsp;11.87 years. Among them were 47 cases of hepatitis B, 8 cases of hepatitis C, 46 cases of non-hepatitis, and 57 cases of liver cirrhosis. In the preoperative liver function assessment, 82 cases were classified as Child-Pugh A grade, while 19 were classified as B. There were 89 cases of single lesions, 12 cases of multiple lesions, 78 cases of lesions smaller than 3 centimeters, 18 cases of lesions ranging from 3 to 5 centimeters, and 5 cases of lesions larger than 5 centimeters. A total of 56 cases of primary malignant tumors and 45 cases of secondary malignant tumors were identified. Postoperative follow-up was carried out until October 2018, with a follow-up period ranging from 6 to 44 months. The average follow-up time was 26.45\u0026thinsp;\u0026plusmn;\u0026thinsp;10.53 months. As of October 2018, there were 22 cases of recurrence, 79 cases of no recurrence, 97 cases of survival, and 4 cases of death. The disease-free survival rates at 1, 2, and 3 years after surgery were 80.2%, 72.3%, and 70.3%, respectively. Similarly, the overall survival rates at 1, 2, and 3 years after surgery were 99%, 97%, and 96%, respectively.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eResults of Single-factor Analysis\u003c/h2\u003e \u003cp\u003eDuring the follow-up observation of 101 patients, it was found that 22 patients experienced recurrence after undergoing microwave ablation treatment, while the remaining 79 patients were recurrence-free. In the recurrent cases, there were 15 males and 7 females. Out of the total, there were 12 cases with cirrhosis, 10 cases with a history of hepatitis, 10 cases with Grade A liver function, 12 cases with Grade B liver function, 15 cases with a single lesion, 7 cases with multiple lesions, and 21 cases with a diameter of \u0026le;\u0026thinsp;5 centimeters. Additionally, there were 11 cases of primary liver tumors and 11 cases of secondary liver tumors. A single-factor analysis was conducted on several variables. The results demonstrated a significant correlation between recurrence and the number of lesions in the Child-Pugh B stage (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). However, there was no correlation between recurrence and gender, age, tumor type, history of hepatitis, or cirrhosis (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Please refer to Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e for specific results.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eUnivariate analysis of factors related to recurrence after percutaneous microwave ablation treatment for hepatic malignant tumors\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eFactor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNumber of Cases\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRecurrence\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNo Recurrence\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003emale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.596\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003efemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.293\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ecirrhosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.84\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHistory of hepatitis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.338\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eChild Pugh grading\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eNumber of lesions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003esingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMultiple\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eLesion size\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;3cm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.407\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3-5cm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.678\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;5cm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.146\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTumor type\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.561\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003esecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eMultiple Factor Analysis Results\u003c/h2\u003e \u003cp\u003eA multifactorial analysis revealed a statistically significant correlation (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) between Child-Pugh B status and the occurrence of postoperative recurrence in patients with recurrent malignant liver tumors treated with microwave ablation. However, no correlation was found between the number, size, and type of lesions and postoperative recurrence, and this lack of correlation was not statistically significant (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Please refer to Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e for detailed results.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMultivariate regression analysis of factors associated with recurrence after percutaneous microwave ablation treatment for hepatic malignant tumors\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFactor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRegression Coefficient\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStandard Error\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRelative Risk\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTumor Type\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-1.315\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.703\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.268\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.061\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChild Classification\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-2.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.768\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.057\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of Lesions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-1.492\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.803\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.225\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.063\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLesion Size\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.161\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.691\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.851\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.816\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eThe Impact of Melting Parameters on the Range\u003c/h2\u003e \u003cp\u003eWe screened the characteristics of 55 cases from the data, which included intraoperative parameters and complete postoperative imaging data at 1 month. It is important to note that all cases in the study had a single lesion. The majority of lesions have a maximum diameter of \u0026le;\u0026thinsp;3cm (which accounts for 96.3% of cases), whereas a minority of cases have a maximum diameter of \u0026le;\u0026thinsp;5cm. 3. Use the same model as the ablation needle. 4. All are single-electrode, single-point ablations. The analysis of ablation power and time reveals that, within a specific range, ablation's transverse and longitudinal diameters gradually increase with the increase in power and time. Statistical significance (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) is observed when the ablation power is set at 60W for a duration of 6 minutes, as compared to 5 minutes. Similarly, when the ablation time is 6 minutes, statistical significance (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) is observed between the ablation power of 60W and 55W or 50W. Please refer to Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eA meta-analysis Provides Additional Confirmation of the Close Relationship Between the Number of Lesions and the Child-Pugh B Grade with the Recurrence of Liver Malignant Tumors in Patients who Undergo Percutaneous Microwave Ablation\u003c/b\u003e \u003c/p\u003e \u003cp\u003eWe conducted a thorough literature search across multiple databases, such as PubMed, EMBASE, Cochrane Library, and CNKI. Keywords include \"microwave ablation\", \"malignant liver tumor\", and \"recurrence\". A total of 1280 articles were retrieved. Duplicates, unrecorded data, comments, expert opinions, case reports, and non-systematic reviews were excluded based on the title. Additionally, articles focusing on combination therapy and liver diseases other than the selected condition were excluded, resulting in 75 articles. Each included article underwent a meticulous screening process to eliminate those lacking statistical recurrence data or reported recurrence without conducting multiple-factor regression analysis. Eventually, 10 retrospective studies were included in the meta-analysis (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Relevant information about the author, publication date, study design, patient characteristics, and key findings were extracted from the article (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eIncorporate basic characteristics of literature.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAuthors\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eYear\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCountry\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003eChild\u0026ndash;Pugh B\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e \u003cp\u003eMultiple nodule\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eHR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTomoki Ryu\u003c/p\u003e \u003cp\u003ePMID:\u0026nbsp;34618325\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eJapan\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.013\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.080\u0026ndash;1.890\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e1.22\u0026ndash;1.87\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKanehiko Suwa\u003c/p\u003e \u003cp\u003ePMID:\u0026nbsp;33675382\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eJapan\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.708\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.696\u0026ndash;1.706\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.051\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1.149\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.999\u0026ndash;1.321\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTianqiang Jin\u003c/p\u003e \u003cp\u003ePMID:\u0026nbsp;32781862\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eChina\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.215\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.511\u0026ndash;2.890\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.004\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e2.825\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e1.401\u0026ndash;5.695\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYun Xu\u003c/p\u003e \u003cp\u003ePMID: 27649577\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eChina\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.657\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.001\u0026ndash;7.052\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTao Wang\u003c/p\u003e \u003cp\u003ePMID:\u0026nbsp;27620527\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eChina\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.515\u0026ndash;1.866\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChenwei Wang\u003c/p\u003e \u003cp\u003ePMID:32449005\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eChina\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e1.05\u0026ndash;2.68\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eZhiwei Chen\u003c/p\u003e \u003cp\u003eCNKI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eChina\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.203\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.481\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.809\u0026ndash;2.714\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e2.547\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e1.532\u0026ndash;4.237\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYuan Lv\u003c/p\u003e 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Xie\u003c/p\u003e \u003cp\u003eCNKI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eChina\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e2.998\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e1.858\u0026ndash;4.836\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTomoki Ryu\u003c/p\u003e \u003cp\u003ePMID: 31359277\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eJapan\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e1.29\u0026ndash;2.08\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"9\"\u003eNote: HR: Hazard Ratio; CI: Confidence Interval\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eFirstly, we aim to analyze the correlation between Child-Pugh B classification and recurrence rates following percutaneous microwave ablation. Upon conducting a preliminary statistical synthesis of the data from the included studies, the I2 test revealed an absence of significant heterogeneity among the groups (I2\u0026thinsp;=\u0026thinsp;0%, p\u0026thinsp;=\u0026thinsp;0.64). Additionally, the funnel plot demonstrated the absence of publication bias (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003eA-B). A fixed-effects model was used for analysis, yielding a pooled hazard ratio (HR) of 1.39 with a 95% confidence interval (CI) of [1.13, 1.72]. The p-value of less than 0.01 suggests a statistically significant increase in the risk of recurrence among patients with Child-Pugh B who underwent percutaneous microwave ablation therapy (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003eC).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eSubsequently, we examined the association between the number of lesions and recurrence following percutaneous microwave ablation. Our analysis revealed considerable heterogeneity among the studies (I\u0026sup2; \u0026gt; 50%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01) (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003eA-B). Thus, we selected the random-effects model for meta-analysis to consider the possible variations among studies. Using random effects models, the analysis revealed a pooled hazard ratio (HR) of 1.69, with a 95% confidence interval (CI) of [1.33, 2.13] and a p-value of less than 0.01, indicating a statistically significant difference (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003eC). These findings suggest that patients with multiple lesions have a significantly higher risk of postoperative recurrence than those with a single lesion. In particular, patients with multiple lesions have a significantly higher risk of postoperative recurrence when compared to those with a single lesion.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThese findings are in line with previous outcomes reported by single-center studies. However, the larger sample size and higher statistical power of the meta-analysis enhance the stability and reliability of these findings.\u003c/p\u003e \u003cp\u003eIn conclusion, our meta-analysis solidifies the strong association between tumor number and Child-Pugh B class and the recurrence of malignant liver tumors following percutaneous microwave ablation. This study offers precise guidance for clinical doctors, enabling them to assess postoperative recurrence risk accurately and develop tailored follow-up strategies for high-risk patients.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003ePercutaneous microwave ablation has emerged as a significant approach for managing malignant liver tumors\u0026nbsp;[20, 21, 22, 23]. This study's finding of a 70.3% 3-year disease-free survival rate post-percutaneous microwave ablation highlights a significant improvement over previous research. This higher survival rate may stem from our innovative research methods and clinical practice. It underscores the potential of MWA as a more effective treatment option compared to traditional methods like surgery or chemotherapy. It could be attributed to our research methods, topics, and clinical practice. However, this proportion also serves as a reminder that nearly one-third of patients will experience relapse after undergoing treatment. This study identified Child-Pugh B class as an independent risk factor for the recurrence of malignant liver tumors. The Child-Pugh classification is a significant indicator reflecting liver function and is directly associated with the post-treatment recovery and the recurrence rate\u0026nbsp;[16, 17, 24]. Our findings are consistent with previous literature reports, confirming the importance of predicting recurrence. It also implies that clinical doctors must accurately evaluate the Child-Pugh classification of patients before treatment to guide the treatment strategy.\u003c/p\u003e\n\u003cp\u003eFurthermore, apart from classifying patients as Child-Pugh B, this study also examined additional potential factors that could influence the recurrence of the condition. However, there is no significant correlation between the number of lesions, the size, and the type of tumor recurrence. This finding diverges from certain reports found in the existing literature, with the divergence possibly stemming from factors like sample selection and regional disparities. However, this result offers a fresh perspective for future research. In conclusion, we have determined that the number of lesions and Child-Pugh B classification positively correlate with postoperative recurrence. Child B stage is an independent risk factor for recurrence in the microwave ablation treatment of malignant liver tumors. The ablation horizontal and vertical diameters gradually increase within a specific range as the ablation power and time increase. Furthermore, noteworthy distinctions can be observed among the horizontal and vertical diameters generated by varying ablation power or time\u0026nbsp;(Figure 6).\u003c/p\u003e\n\u003cp\u003eIn this study, both the power and duration of ablation were found to impact the range of ablation significantly. As the power and time of ablation increase, the range of ablation gradually expands. A notable difference exists in the effect produced by ablating for 5 and 6 minutes, particularly when employing a power of 60W. This study provides valuable information for clinical practice, highlighting the significance of selecting suitable ablation parameters to enhance treatment efficacy. Based on the findings above, evaluating the Child-Pugh classification of the patient is recommended before conducting percutaneous microwave ablation therapy. Subsequently, suitable treatment strategies should be selected. Simultaneously, selecting the suitable ablation power and duration is pivotal for enhancing the therapeutic effectiveness. Physicians should adapt the ablation parameters according to the patient's specific conditions, taking into account factors such as the size and location of the lesion. Our research demonstrates a comparatively higher 3-year disease-free survival rate than other related studies. However, there are disparities in the factors that influence recurrence. It could be attributed to various factors, including research methods, patient selection, and geographical considerations. However, diverse research findings offer a more comprehensive perspective, enhancing our understanding of treating liver malignancies.\u003c/p\u003e\n\u003cp\u003eAlthough our findings are promising, it's important to acknowledge the study's limitations, such as potential selection bias due to the single-hospital sample. Future studies should aim for a broader, multicenter approach to confirm and expand upon these results, offering a more comprehensive understanding of MWA's efficacy. Secondly, certain potential influencing factors may not have been accounted for. In the future, we aim to perform larger sample and multicenter studies to further validate and expand upon the findings of this research. In summary, this study confirmed the efficacy of percutaneous microwave ablation for treating malignant liver tumors.\u003c/p\u003e\n\u003cp\u003eAdditionally, it identified Child-Pugh B grade as a significant and independent risk factor for tumor recurrence. This study provides important guidance for clinical treatment. Moreover, our research has uncovered the impact of ablation power and duration on therapeutic effectiveness, which offers valuable insights for clinical applications. Despite its limitations, this study should not be overlooked due to its scientific and clinical value, which includes providing strong references and guidance for future research and clinical practice.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAvailability of data\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll the data is available\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was funded by the General Program of the National Natural Science Foundation of China (No. 82372070).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe author declares no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u003c/strong\u003e\u003cstrong\u003e’\u003c/strong\u003e\u003cstrong\u003econtributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNing Cong and Hua Chen played crucial roles in research design and data collection, while Jinpeng Li and Yutian Jiang were involved in data analysis and result interpretation. Jutian Shi conducted literature review and meta-analysis, providing further support and evidence for the study. The collaboration of these authors made it possible to evaluate the therapeutic efficacy of MWA in treating hepatic malignant tumors and identifying factors related to recurrence, offering valuable reference information for clinicians in treatment decisions and follow-up procedures.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted in accordance with ethical principles and was approved by the Ethics Committee of the Shandong Cancer Hospital and Institute, Shandong Province.(No.201801024) All patients provided informed consent to participate in the study before undergoing percutaneous microwave ablation (MWA) treatment for hepatic malignant tumors. The research followed established ethical guidelines to ensure patient confidentiality, data integrity, and respect for individual rights. Participation in the study was voluntary, and patients were informed about the nature of the research, potential risks and benefits, and their right to withdraw at any time without any impact on their medical care. The study adhered to ethical standards to safeguard the well-being and rights of the participants involved.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eBrown, Zachary J et al. \u0026ldquo;Management of Hepatocellular Carcinoma: A Review.\u0026rdquo; JAMA surgery vol. 158,4 (2023): 410-420. doi:10.1001/jamasurg.2022.7989\u003c/li\u003e\n \u003cli\u003eLiu, Dongming, and Tianqiang Song. \u0026ldquo;Changes in and challenges regarding the surgical treatment of hepatocellular carcinoma in China.\u0026rdquo; Bioscience trends vol. 15,3 (2021): 142-147. doi:10.5582/bst.2021.01083\u003c/li\u003e\n \u003cli\u003eLucchina, Natalie et al. \u0026ldquo;Current role of microwave ablation in the treatment of small hepatocellular carcinomas.\u0026rdquo; Annals of gastroenterology vol. 29,4 (2016): 460-465. doi:10.20524/aog.2016.0066\u003c/li\u003e\n \u003cli\u003eForner, Alejandro et al. \u0026ldquo;Hepatocellular carcinoma.\u0026rdquo; Lancet (London, England) vol. 379,9822 (2012): 1245-55. doi:10.1016/S0140-6736(11)61347-0\u003c/li\u003e\n \u003cli\u003eVogel, Arndt et al. \u0026ldquo;Hepatocellular carcinoma.\u0026rdquo; Lancet (London, England) vol. 400,10360 (2022): 1345-1362. doi:10.1016/S0140-6736(22)01200-4\u003c/li\u003e\n \u003cli\u003eRaoul, Jean-Luc et al. \u0026ldquo;Updated use of TACE for hepatocellular carcinoma treatment: How and when to use it based on clinical evidence.\u0026rdquo; Cancer treatment reviews vol. 72 (2019): 28-36. doi:10.1016/j.ctrv.2018.11.002\u003c/li\u003e\n \u003cli\u003eJiř\u0026iacute;, Tom\u0026aacute;\u0026scaron;ek et al. \u0026ldquo;Hepatocellular carcinoma future treatment options.\u0026rdquo; \u0026ldquo;Budouc\u0026iacute; mo\u0026amp;#382;nosti l\u0026eacute;\u0026amp;#269;by hepatocelul\u0026aacute;rn\u0026iacute;ho karcinomu.\u0026rdquo; Klinicka onkologie : casopis Ceske a Slovenske onkologicke spolecnosti vol. 33,Supplementum 3 (2020): 26-29. doi:10.14735/amko20203S26\u003c/li\u003e\n \u003cli\u003eLiu, Jie et al. \u0026ldquo;Percutaneous microwave ablation liver partition and portal vein embolization for planned hepatectomy due to large gastrointestinal stromal tumor metastases: A case report.\u0026rdquo; Medicine vol. 96,42 (2017): e8271. doi:10.1097/MD.0000000000008271\u003c/li\u003e\n \u003cli\u003eTomita, Koji et al. \u0026ldquo;Evidence on percutaneous radiofrequency and microwave ablation for liver metastases over the last decade.\u0026rdquo; Japanese journal of radiology vol. 40,10 (2022): 1035-1045. doi:10.1007/s11604-022-01335-5\u003c/li\u003e\n \u003cli\u003eTakahashi, Hideo, and Eren Berber. \u0026ldquo;Role of thermal ablation in the management of colorectal liver metastasis.\u0026rdquo; Hepatobiliary surgery and nutrition vol. 9,1 (2020): 49-58. doi:10.21037/hbsn.2019.06.08\u003c/li\u003e\n \u003cli\u003eSantambrogio, Roberto et al. \u0026ldquo;Laparoscopic Microwave Ablation: Which Technologies Improve the Results.\u0026rdquo; Cancers vol. 15,6 1814. 17 Mar. 2023, doi:10.3390/cancers15061814\u003c/li\u003e\n \u003cli\u003eJiang, Yingxu et al. \u0026ldquo;A coaxial slot antenna with frequency of 433 MHz for microwave ablation therapies: design, simulation, and experimental research.\u0026rdquo; Medical \u0026amp; biological engineering \u0026amp; computing vol. 55,11 (2017): 2027-2036. doi:10.1007/s11517-017-1651-9\u003c/li\u003e\n \u003cli\u003ePoggi, Guido et al. \u0026ldquo;Microwave ablation of hepatocellular carcinoma.\u0026rdquo; World journal of hepatology vol. 7,25 (2015): 2578-89. doi:10.4254/wjh.v7.i25.2578\u003c/li\u003e\n \u003cli\u003eHuber, Timothy C et al. \u0026ldquo;Percutaneous Therapies for Hepatocellular Carcinoma: Evolution of Liver Directed Therapies.\u0026rdquo; Journal of hepatocellular carcinoma vol. 8 1181-1193. 23 Sep. 2021, doi:10.2147/JHC.S268300\u003c/li\u003e\n \u003cli\u003eKok, Beverley, and Juan G Abraldes. \u0026ldquo;Child-Pugh Classification: Time to Abandon?.\u0026rdquo; Seminars in liver disease vol. 39,1 (2019): 96-103. doi:10.1055/s-0038-1676805\u003c/li\u003e\n \u003cli\u003eChen, Ching-Tso et al. \u0026ldquo;Prognosis and treatment pattern of advanced hepatocellular carcinoma after failure of first-line atezolizumab and bevacizumab treatment.\u0026rdquo; Hepatology international vol. 16,5 (2022): 1199-1207. doi:10.1007/s12072-022-10392-x\u003c/li\u003e\n \u003cli\u003eRomano, Fabrizio et al. \u0026ldquo;Rethinking the Barcelona clinic liver cancer guidelines: Intermediate stage and Child-Pugh B patients are suitable for surgery?.\u0026rdquo; World journal of gastroenterology vol. 27,21 (2021): 2784-2794. doi:10.3748/wjg.v27.i21.2784\u003c/li\u003e\n \u003cli\u003ePetr, Urb\u0026aacute;nek, and Hř\u0026iacute;bek Petr. \u0026ldquo;Hepatocellular carcinoma from the view of gastroenterologist/hepatologist.\u0026rdquo; \u0026ldquo;Hepatocelul\u0026aacute;rn\u0026iacute; karcinom z pohledu gastroenterologa/hepatologa.\u0026rdquo; Klinicka onkologie : casopis Ceske a Slovenske onkologicke spolecnosti vol. 33,Supplementum 3 (2020): 34-44. doi:10.14735/amko20203S34\u003c/li\u003e\n \u003cli\u003eHernandez, Adrian V et al. \u0026ldquo;Meta-Analysis.\u0026rdquo; Chest vol. 158,1S (2020): S97-S102. doi:10.1016/j.chest.2020.03.003\u003c/li\u003e\n \u003cli\u003eShiina, Shuichiro et al. \u0026ldquo;Percutaneous Ablation for Hepatocellular Carcinoma: Comparison of Various Ablation Techniques and Surgery.\u0026rdquo; Canadian journal of gastroenterology \u0026amp; hepatology vol. 2018 4756147. 3 Jun. 2018, doi:10.1155/2018/4756147\u003c/li\u003e\n \u003cli\u003eDumolard, Lucile et al. \u0026ldquo;Percutaneous Ablation-Induced Immunomodulation in Hepatocellular Carcinoma.\u0026rdquo; International journal of molecular sciences vol. 21,12 4398. 20 Jun. 2020, doi:10.3390/ijms21124398\u003c/li\u003e\n \u003cli\u003eDong, Tian-Tian et al. \u0026ldquo;Clinical Results, Risk Factors, and Future Directions of Ultrasound-Guided Percutaneous Microwave Ablation for Hepatocellular Carcinoma.\u0026rdquo; Journal of hepatocellular carcinoma vol. 10 733-743. 15 May. 2023, doi:10.2147/JHC.S409011\u003c/li\u003e\n \u003cli\u003eAbdalla, Moustafa et al. \u0026ldquo;Surgical approach to microwave and radiofrequency liver ablation for hepatocellular carcinoma and colorectal liver metastases less than 5 cm: a systematic review and meta-analysis.\u0026rdquo; Surgical endoscopy vol. 37,5 (2023): 3340-3353. doi:10.1007/s00464-022-09815-5\u003c/li\u003e\n \u003cli\u003eTerada, H et al. Ryoikibetsu shokogun shirizu ,7 (1995): 151-4.\u003cstrong\u003e\u003c/strong\u003e\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Hepatic malignant tumors, Percutaneous microwave ablation, Tumor recurrence, Child-Pugh B classification, Lesion count.","lastPublishedDoi":"10.21203/rs.3.rs-4353630/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4353630/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThe treatment of hepatic malignant tumors poses a significant global health challenge, often managed through percutaneous microwave ablation (MWA). Understanding the effectiveness of MWA and the factors influencing tumor recurrence is essential for improving patient outcomes. Methods: In this study, a cohort of 101 patients out of 249 with hepatic malignant tumors treated at the Shandong Cancer Hospital and Institute were analyzed. The study evaluated disease-free and overall survival rates at 1, 2, and 3 years post-MWA, exploring correlations between tumor recurrence and variables such as Child-Pugh B liver function classification and lesion count. Additionally, a meta-analysis was conducted to identify independent risk factors for recurrence following MWA treatment. Results: Disease-free survival rates of 80.2%, 72.3%, and 70.3% at 1, 2, and 3 years post-MWA were observed, alongside overall survival rates of 99%, 97%, and 96%. Noteworthy associations were found between tumor recurrence and Child-Pugh B classification, as well as the number of lesions. The meta-analysis further supported lesion count and Child-Pugh B classification as independent risk factors for recurrence post-MWA. Conclusion: Child-Pugh B classification and lesion count emerge as pivotal factors in predicting tumor recurrence post-MWA treatment for hepatic malignant tumors. These insights offer valuable guidance to clinicians in treatment decisions and post-treatment monitoring strategies, potentially leading to improved patient care and outcomes.\u003c/p\u003e","manuscriptTitle":"Enhancing Patient Outcomes through Microwave Ablation in Hepatic Malignant Tumors: Insights on Recurrence Factors","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-05-10 20:10:00","doi":"10.21203/rs.3.rs-4353630/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"0da91ca8-b12d-4f6e-b35b-f9e76292db9f","owner":[],"postedDate":"May 10th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-05-13T02:55:35+00:00","versionOfRecord":[],"versionCreatedAt":"2024-05-10 20:10:00","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4353630","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4353630","identity":"rs-4353630","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}