Clinical applicability of synchronous vs sequential transarterial chemoembolization and microwave ablation in hepatocellular carcinoma

Table 1 Representative evidence comparing synchronous and sequential transarterial chemoembolization-microwave ablation in hepatocellular carcinoma

Ref.	Study design	Sample size	Treatment strategy	Key outcomes	Major limitations
Wang et al[49]	Retrospective (PSM)	180	Sync vs seq	Similar short-term efficacy	Short follow-up
Shi et al[8]	Prospective	96	Sync + Immunotherapy	Improved response	No control group
Xu et al[52]	Prospective	110	TACE + MWA	Better local control	Limited generalizability
Zhao et al[17]	Meta-analysis	12 studies	Combo vs monotherapy	Better PFS	Heterogeneity
Ni et al[13]	Meta-analysis	-	Combo vs monotherapy	Better tumor control	No RCT
Abdelaziz et al[14]	Clinical trial	73	TACE + MWA	Feasible and safe	Small sample
Peng et al[12]	RCT	189	TACE + ablation	Better survival	Radiofrequency ablation-based

PSM: Propensity score matching; TACE: Transarterial chemoembolization; MWA: Microwave ablation; PFS: Progression-free survival; RCT: Randomized controlled trial.

Table 2 Clinical decision framework for synchronous vs sequential transarterial chemoembolization-microwave ablation

Clinical factor	Synchronous approach	Sequential approach
Tumor size	Small (≤ 3 cm)	Large (> 3 cm)
Tumor number	Solitary or oligofocal	Multiple/multifocal
Liver function	Good (Child-Pugh A)	Borderline (Child-Pugh B)
Tumor location	Accessible/superficial	Complex/deep/perivascular
ECOG performance	0-1	2
Treatment goal	Curative intent	Palliative/control
Expected tolerance	Good tolerance	Compromised tolerance
Follow-up capability	Reliable follow-up	Regular monitoring feasible

ECOG: Eastern Cooperative Oncology Group.