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Comparing the efficacy of immune checkpoint inhibitors with and without microwave ablation in advanced hepatocellular carcinoma in real‑world clinical practice: A retrospective cohort study

  • Authors:
    • Chun Wei
    • Sizhong Chen
    • Li Ding
    • Ting Zhou
    • Fan Huang
    • Yong Wang
    • Ou Jiang
    • Yu Liu
  • View Affiliations / Copyright

    Affiliations: Department of Oncology, The Second People's Hospital of Neijiang, Neijiang, Sichuan 641000, P.R. China, Department of Oncology, Dechang County People's Hospital, Xichang, Sichuan 615500, P.R. China, Department of Oncology, Chuantou Xichang Hospital, Xichang, Sichuan 615500, P.R. China, Department of Oncology, First People's Hospital of Neijiang, Neijiang, Sichuan 641000, P.R. China
    Copyright: © Wei et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
  • Article Number: 278
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    Published online on: May 4, 2026
       https://doi.org/10.3892/ol.2026.15633
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Abstract

Immune checkpoint inhibitors (ICIs) are widely used in the treatment of hepatocellular carcinoma (HCC). Microwave ablation (MWA), a form of thermal ablation, may elicit systemic immune responses and could potentially augment the clinical activity of ICIs, particularly in advanced disease. The present study retrospectively assessed 52 eligible patients with limited progression or oligometastatic disease treated between January 2022 and January 2024 with either ICIs alone or ICIs plus MWA. A total of 21 patients received the combination regimen (predominantly programmed cell death protein 1 inhibitors), and 31 received ICI monotherapy. The recorded baseline characteristics did not suggest notable between‑group imbalances; however, key tumor burden descriptors were incompletely captured, and residual confounding cannot be excluded. The objective response rate (ORR) and disease control rate (DCR) were 9.7 and 51.6% with ICIs alone, respectively, vs. 28.6 and 81.0% with ICIs plus MWA. The DCR was higher in the combination group (P=0.031), whereas the between‑group difference in ORR was not statistically significant (P=0.133) compared with the monotherapy group. Median overall survival (OS) was 11.0 months with monotherapy and 16.8 months with combination therapy (log‑rank P=0.008). In the multivariable Cox analysis, the combination therapy was associated with improved OS (adjusted HR=0.176; 95% CI, 0.048‑0.642; Wald P=0.008); however, given the small sample size and limited number of OS events, this adjusted HR may be imprecise and sensitive to model specification and should be interpreted as exploratory. The median progression‑free survival (PFS) was 4.0 vs. 9.0 months (log‑rank P<0.001), consistent with the multivariable model (adjusted HR=0.270; 95% CI, 0.122‑0.595; Wald P=0.001). There was not a clear unexpected safety pattern observed, but safety comparisons were descriptive only and underpowered. In the present retrospective cohort of selected patients with advanced HCC and limited progression/oligometastatic disease, ICIs plus MWA was associated with longer PFS and OS compared with ICIs alone. The interpretation is limited by the small sample size, potential residual confounding and model instability. The direction of benefit was consistent across Kaplan‑Meier and Cox analyses, although the adjusted OS effect estimate may be imprecise. The present study was registered on ClinicalTrials.gov on 03 September 2024 (trial no. NCT06581497).
View Figures

Figure 1

Patient selection flow. MWA,
microwave ablation; PD-1, programmed cell death protein 1; CR,
complete response; PR, partial response.

Figure 2

Waterfall plot of target lesion size.
Percentage change in target lesion size compared with baseline in
52 patients. The percentage change was calculated from modified
Response Evaluation Criteria in Solid Tumors target-lesion
measurements used for routine response assessment and does not
represent standardized baseline whole-disease tumor burden
variables (such as structured maximum lesion diameter or metastatic
site coding). MWA, microwave ablation; ICIs, immune checkpoint
inhibitors.

Figure 3

Swimmer plot of response duration and
current status for the 52 patients. MWA, microwave ablation; ICIs,
immune checkpoint inhibitors; CR, complete response; PR, partial
response; SD, stable disease; PD, progressive disease.

Figure 4

Comparison of imaging before and
after combined treatment for patients. (A) CT scan of a 49-year-old
male patient revealed tumor recurrence following transcatheter
arterial embolization. (B) At 1 month after undergoing microwave
ablation, a follow-up CT scan showed no enhancement in the tumor
area. (C) A 69-year-old female patient, who had undergone liver
resection, was found to have a right intrahepatic metastatic nodule
measuring 1.1 cm in diameter on an enhanced CT scan 3 months
post-surgery. (D) At 2 months after microwave ablation, a
re-examination CT scan showed no enhancement in the tumor area.

Figure 5

Comparison of pre- and post-treatment
MRI of a patient undergoing combination therapy. (A) Baseline
T1-weighted image shows a new lesion in the right lobe of the
liver. (B) Baseline arterial-phase contrast-enhanced MRI shows
typical arterial hyperenhancement of the lesion. (C) Baseline
portal venous-phase image shows washout. (D) At 1 month after
microwave ablation combined with immunotherapy, follow-up
T1-weighted image shows the treated lesion/ablation zone. (E)
Follow-up arterial-phase image shows no notable enhancement. (F)
Follow-up portal venous-phase image also shows no notable
enhancement.

Figure 6

Imaging examination of patients who
responded to combination therapy. (A) At initial diagnosis
(November 2022), a mass was identified in the caudate lobe of the
liver. (B) On re-examination (January 2023), the mass had increased
in size. (C) CT scan after transarterial chemoembolization (TACE)
showing lipiodol deposition within the tumor. (D) The intrahepatic
lesion recurred 2 months after first-line treatment. (E) The
patient subsequently underwent MWA. (F) Follow-up CT scan at 6
months showing the post-ablation zone. (G) Follow-up CT scan at 7
months demonstrating continued stable disease. (H) An enhanced CT
scan revealed a reduction in tumor size from 4.5 cm at baseline to
2.2 cm after MWA treatment. (I) The dynamic changes in lesion size
before and after MWA are shown. (J) The dynamic curve of serum AFP
concentration before and after MWA is illustrated. The red arrow in
diagram I and J indicates the time point of ablation. MWA,
microwave ablation; AFP, α-fetoprotein; TACE, transarterial
chemoembolization.

Figure 7

Kaplan-Meier curves of OS and PFS for
the two groups. (A) The OS of the entire population. (B) The PFS of
the entire population. (C) OS of two groups of patients. (D) PFS of
two groups of patients. The red line represents the MWA combined
with ICI treatment group, and the blue line represents the ICI
monotherapy group. Plus, ICIs in collaboration with MWA; alone,
ICIs; OS, overall survival; PFS, progression-free survival; MWA,
microwave ablation; ICIs, immune checkpoint inhibitors.

Figure 8

Kaplan-Meier curves of OS and PFS in
the AFP subgroups. (A) OS in patients with AFP ≥400 ng/ml. (B) PFS
in patients with AFP ≥400 ng/ml. (C) OS in patients with AFP
<400 ng/ml. (D) PFS in patients with AFP <400 ng/ml. The red
line represents the MWA plus ICIs group, and the blue line
represents the ICIs monotherapy group. Plus, ICIs in collaboration
with MWA; alone, ICIs; OS, overall survival; PFS, progression-free
survival; MWA, microwave ablation; ICIs, immune checkpoint
inhibitors; AFP, α-fetoprotein.
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Copy and paste a formatted citation
Spandidos Publications style
Wei C, Chen S, Ding L, Zhou T, Huang F, Wang Y, Jiang O and Liu Y: Comparing the efficacy of immune checkpoint inhibitors with and without microwave ablation in advanced hepatocellular carcinoma in real‑world clinical practice: A retrospective cohort study. Oncol Lett 32: 278, 2026.
APA
Wei, C., Chen, S., Ding, L., Zhou, T., Huang, F., Wang, Y. ... Liu, Y. (2026). Comparing the efficacy of immune checkpoint inhibitors with and without microwave ablation in advanced hepatocellular carcinoma in real‑world clinical practice: A retrospective cohort study. Oncology Letters, 32, 278. https://doi.org/10.3892/ol.2026.15633
MLA
Wei, C., Chen, S., Ding, L., Zhou, T., Huang, F., Wang, Y., Jiang, O., Liu, Y."Comparing the efficacy of immune checkpoint inhibitors with and without microwave ablation in advanced hepatocellular carcinoma in real‑world clinical practice: A retrospective cohort study". Oncology Letters 32.1 (2026): 278.
Chicago
Wei, C., Chen, S., Ding, L., Zhou, T., Huang, F., Wang, Y., Jiang, O., Liu, Y."Comparing the efficacy of immune checkpoint inhibitors with and without microwave ablation in advanced hepatocellular carcinoma in real‑world clinical practice: A retrospective cohort study". Oncology Letters 32, no. 1 (2026): 278. https://doi.org/10.3892/ol.2026.15633
Copy and paste a formatted citation
x
Spandidos Publications style
Wei C, Chen S, Ding L, Zhou T, Huang F, Wang Y, Jiang O and Liu Y: Comparing the efficacy of immune checkpoint inhibitors with and without microwave ablation in advanced hepatocellular carcinoma in real‑world clinical practice: A retrospective cohort study. Oncol Lett 32: 278, 2026.
APA
Wei, C., Chen, S., Ding, L., Zhou, T., Huang, F., Wang, Y. ... Liu, Y. (2026). Comparing the efficacy of immune checkpoint inhibitors with and without microwave ablation in advanced hepatocellular carcinoma in real‑world clinical practice: A retrospective cohort study. Oncology Letters, 32, 278. https://doi.org/10.3892/ol.2026.15633
MLA
Wei, C., Chen, S., Ding, L., Zhou, T., Huang, F., Wang, Y., Jiang, O., Liu, Y."Comparing the efficacy of immune checkpoint inhibitors with and without microwave ablation in advanced hepatocellular carcinoma in real‑world clinical practice: A retrospective cohort study". Oncology Letters 32.1 (2026): 278.
Chicago
Wei, C., Chen, S., Ding, L., Zhou, T., Huang, F., Wang, Y., Jiang, O., Liu, Y."Comparing the efficacy of immune checkpoint inhibitors with and without microwave ablation in advanced hepatocellular carcinoma in real‑world clinical practice: A retrospective cohort study". Oncology Letters 32, no. 1 (2026): 278. https://doi.org/10.3892/ol.2026.15633
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