# Predictive Value of Radiographic Tumor Burden Score in Hepatocellular Carcinoma Within Milan Criteria After Microwave Ablation: Implications for Long‐Term Outcomes and Treatment Planning

## TL;DR

This study shows that a radiographic tumor burden score can predict long-term survival and recurrence in liver cancer patients after microwave ablation treatment.

## Contribution

The study demonstrates that tumor burden score is a novel predictor of outcomes in hepatocellular carcinoma patients treated with microwave ablation.

## Key findings

- High tumor burden score is associated with lower 5-year overall and recurrence-free survival rates.
- Laparoscopic microwave ablation improves recurrence-free survival in high tumor burden score patients.
- Tumor burden score is an independent risk factor for survival outcomes after microwave ablation.

## Abstract

This study aimed to investigate the predictive value of the radiographic tumor burden score (TBS) for long‐term outcomes in hepatocellular carcinoma (HCC) patients meeting Milan criteria after microwave ablation (MWA) and to delineate its significance in guiding treatment planning.

Retrospective analysis was conducted on clinical data from 198 HCC patients meeting Milan criteria, who underwent MWA at our hospital from January 2011 to December 2018. Using X‐tile software, the optimal critical value of TBS was determined, leading to the categorization of patients into high‐ and low‐TBS groups. Propensity score matching (PSM) was applied to balance covariates between these groups.

Before PSM, the 5‐year overall survival (OS) rate and recurrence‐free survival (RFS) rate in the high‐TBS (47 cases) and low‐TBS groups (151 cases) were 32.8% versus 59.7% (p = 0.033) and 23.4% versus 50.9% (p = 0.016), respectively. Following PSM, the 5‐year OS rate and RFS rate in the high‐TBS (44 cases) and low‐TBS groups (95 cases) were 30.2% versus 64.1% (p = 0.011) and 21.9% versus 45.9% (p = 0.0059), respectively. Cox analysis identified high TBS and percutaneous microwave ablation (PMWA) as independent risk factors for OS and RFS. The stratified analysis revealed that the median RFS time for patients undergoing laparoscopic microwave ablation (LMWA) (20 cases) and PMWA (24 cases) in the high‐TBS group (44 cases) was 45 and 10.5 months, respectively (p = 0.006).

TBS emerged as a robust predictor for the long‐term outcomes of HCC within Milan criteria after MWA. A higher TBS was associated with a diminished long‐term survival rate. Notably, among HCC patients meeting Milan criteria, those with TBS > 3 exhibited a prolonged median RFS time following LMWA compared to PWMA.

TBS proves to be a valuable predictor for the long‐term outcomes of HCC patients meeting Milan criteria after MWA. A higher TBS is associated with a lower long‐term survival rate. Notably, among HCC patients meeting Milan criteria, those with TBS > 3 exhibited an extended median RFS time after LMWA treatment.