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©The Author(s) 2026. Published by Baishideng Publishing Group Inc. All rights reserved.
Multibipolar radiofrequency vs single needle microwave ablation for the treatment of newly diagnosed hepatocellular carcinoma
Cécilia Bahloul, Agnès Rode, Pierre Pradat, Laurent Milot, Jérôme Dumortier, Philippe Merle, Jean-Yves Mabrut, Loïc Boussel, Angelo Della Corte
Cécilia Bahloul, Agnès Rode, Laurent Milot, Loïc Boussel, Angelo Della Corte, Department of Radiology, Hospices Civils de Lyon, Lyon 69002, Auvergne-Rhône-Alpes, France
Pierre Pradat, Centre de Recherche Clinique, Hospices Civils de Lyon, Lyon 69002, Auvergne-Rhône-Alpes, France
Jérôme Dumortier, Department of Digestive Diseases, Hospices Civils de Lyon, Lyon 69002, Auvergne-Rhône-Alpes, France
Philippe Merle, Hepatology Unit, Hospices Civils de Lyon, Lyon 69002, Auvergne-Rhône-Alpes, France
Jean-Yves Mabrut, Department of Digestive Surgery and Liver Transplant, Hospices Civils de Lyon, Lyon 69002, Auvergne-Rhône-Alpes, France
Author contributions: Bahloul C contributed to the formal analysis, data curation, visualization, and writing - original draft preparation; Bahloul C, Rode A, Pradat P, and Della Corte A contributed to the conceptualization, methodology, investigation, and resources; Rode A, Pradat P, and Della Corte A contributed to the supervision; Bahloul C, Rode A, Pradat P, Milot L, Dumortier J, Merle P, Mabrut JY, Boussel L, and Della Corte A contributed to the validation and writing - review & editing.
Institutional review board statement: Institutional review board approval was obtained by the Comité Scientifique et Éthique des Hospices Civils de Lyon.
Informed consent statement: A non-opposition notice was sent to each patient included in the study.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The database of the patient cohort is available upon contact with the corresponding author.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Angelo Della Corte, Department of Radiology, Hospices Civils de Lyon, 103 Gd Rue de la Croix-Rousse, Lyon 69002, Auvergne-Rhône-Alpes, France.
a.dellacortetartaglione@gmail.com
Received: September 4, 2025
Revised: October 1, 2025
Accepted: November 24, 2025
Published online: January 14, 2026
Processing time: 130 Days and 19.1 Hours
BACKGROUND
Data comparing the outcomes of hepatocellular carcinoma (HCC) ablation by multibipolar radiofrequency ablation (mbp-RFA) and microwave ablation (MWA) are lacking. This study compares safety and efficacy of the two techniques in treatment-naive HCC.
AIM
To compare the risk of local tumor progression (LTP) according to the technique; secondary endpoints included technique efficacy rate at one-month, overall survival and major complication rate.
METHODS
A bi-institutional retrospective analysis of patients undergoing treatment-naive HCC ablation by either technique was performed. Inverse probability of treatment weighting was used to compare the two groups. Mixed effects multivariate Cox regression was applied to identify risk factors for LTP.
RESULTS
A total of 362 patients (mean age, 66.1 ± 6.2 years, 308 men) were included, of which 242 (323 tumors) treated by mbp-RFA and 120 (168 tumors) by MWA. After a median follow-up of 27 months, cumulative LTP was 11.4% after mbp-RFA and 25.2% after MWA. Independent risk factors for LTP at multivariate analysis were MWA (hazard ratio = 2.85, P < 0.001) and tumor size (hazard ratio = 1.08, P < 0.001). Two-year LTP-free survival was higher after mbp-RFA than MWA regardless of size (< 3 cm: 96% vs 87.1%, P < 0.01; ≥ 3 cm: 87.5% vs 74%, P = 0.04). Technique efficacy rate was higher after mbp-RFA (94.1% vs 87.5%, P = 0.01). No difference was observed in major complication rate (9.5% vs 7.5%, P = 0.59), nor 5-year overall survival (63.6% vs 58.3%, P = 0.33).
CONCLUSION
Mbp-RFA leads to better local tumor control of treatment-naïve HCC than MWA regardless of tumor size and has better primary efficacy, while maintaining a comparable safety profile.
Core Tip: There is limited data comparing multibipolar radiofrequency ablation (mbp-RFA) and microwave ablation (MWA) for treating hepatocellular carcinoma (HCC). This study analyzed 362 patients with newly diagnosed HCC who underwent either mbp-RFA (242 patients, 323 tumors) or MWA (120 patients, 168 tumors). Results showed that mbp-RFA provided better local tumor control, with a lower local tumor progression rate (11.4% vs 25.2%) and a higher complete ablation rate (94.1% vs 87.5%) compared to MWA. The advantage of mbp-RFA was particularly significant for tumors larger than 3 cm, where MWA had a local tumor progression rate of 60.9% vs 21.6% with mbp-RFA. Despite these differences in efficacy, both techniques had similar major complication rates (9.5% vs 7.5%). These findings suggest that mbp-RFA is a more effective option for larger, treatment-naïve HCC tumors while maintaining a comparable safety profile.
