Abstract: Objective The purpose of this study was to investigate the clinical efficacy of transhepatic arterial chemoembolization (TACE) with sequential microwave ablation (MWA) followed by oral sorafenib maintenance in treatment of patients with large hepatocellular carcinoma (HCC). Methods A total of 144 patients with large HCC were encountered in our hospital between April 2017 and April 2019, and 74 patients were treated by TACE with sequential MWA followed by oral sorafenib maintenance and another 70 patients received TACE and oral sorafenib. All patients were followed-up for two years. Results At the end of three month, the objective remission rate and disease control rate in the combination group were 73.0% and 98.6%, both significantly higher than 47.1% and 88.6%(P＜0.05) in TACE-treated patients; serum AFP level was (128.0±14.4)μg/L, significantly lower than [(208.7±27.3)μg/L, P＜0.05], and KPS's score was (88.7±8.2), significantly higher than [(79.4±7.9), P＜0.05] in TACE-treated patients; the incidence of post-operational complications was 39.2%, not significantly different compared to 34.3% in TACE-treated patients (P＞0.05); the incidence of diarrhea, anorexia, alopecia, nausea and vomiting, and skin reactions were 24.3%, 27.0%, 20.3%, 13.5% and 18.9%, not significantly different compared to 24.3%, 30.0%, 24.3%, 17.1% and 18.6% in TACE-treated patients (P＞0.05); at the end of two-year followed-up, 5 cases and 2 cases were lost in the two groups respectively, and the one-year survival rate in the combination group was 97.1%(67/69) and the two-year survival rate was 73.9%(51/69), both significantly higher than 79.4%(54/68) and 52.9%(36/68) in TACE-treated patients (Log-Rank=11.857, P=0.001). Conclusion The strategy of TACE with sequential MWA and oral sorafenib maintenance in treating patients with large-volume HCC is encouraging, which warrants further clinical investigation.

Key words: Hepatoma, Transhepatic arterial chemoembolization, Microwave ablation, Sorafenib, Therapy