***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objective To evaluate the efficacy and prognostic factors associated with transcatheter arterial chemoembolization ( TACE ) combined with microwave ablation ( MWA ) versus TACE alone for a large solitary or multinodular hepatocellular carcinomas ( HCCs ) . Material s and Methods This retrospective study involved 258 patients with a large solitary or multinodular HCCs ( not more than 10 tumors ) who underwent TACE + MWA ( n = 92 ) or TACE alone ( n = 166 ) between July 2011 and April 2015 .  Local tumor control , survival outcomes , and complications were compared between the two groups . Prognostic factors for time to progression ( TTP ) and overall survival ( OS ) were evaluated by univariate and multivariate analyses . Results The median duration of follow-up was 21.2 months ( range , 4–45 months ) . The median TTP and OS were 12.5 months and 26.6 months , respectively , for the TACE + MWA group and 6.7 months and 17.1 months , respectively , for the TACE group ( p < 0.001 ) . The 1- , 2- , and 3-year OS rates were 85.9 , 59.8 , and 32.6 % , respectively , for the TACE + MWA group and 59.0 , 40.4 , and 11.4 % , respectively , for the TACE group ( p < 0.001 ) . The corresponding recurrence rates were 47.8 , 78.3 , and 94.6 % for the TACE + MWA group , respectively , and 74.7 , 96.4 , and 97.6 % , respectively , for the TACE group ( p < 0.001 ) . Logistic regression analyses showed that the treatment method , tumor size , and tumor number were significant prognostic factors for TTP and OS . Conclusion TACE + MWA appears to have more advantages compared to TACE in prolonging OS , with a satisfactory TTP , for in patients with solitary large or multinodular HCCs . Treatment method , tumor size , and tumor number are significant prognostic factors for TTP and OS . Further r and omized , multi-center , prospect i ve trials are required to confirm the findings of this study Purpose To compare MWA and RFA combined with TACE for HCC nodules exceeding 3 cm . Methods 19 lesions su bmi tted to MWA ( G1 ) were retrospectively compared with a combined treatment group ( G2 ) matching by tumor characteristics ( mean size 43 and 45 mm in G1 and G2 , respectively ) . Technical success , complications , complete ablation ( CA ) , and maintained CA ( mCA ) were evaluated . Results Technical success was achieved in all cases . Overall mortality was zero , both in G1 and G2 . No significant differences were found in complications rates ( 3 in G1 and 2 in G2 ) . CA was obtained in 11 ( 58 % ) HCC in G1 and 15 ( 79 % ) in G2 ( p = n.s . ) . CA was obtained in 75.5 % ( G1 ) and 89 % ( G2 ) nodules up to 4 cm , 45 % and 70 % nodules > 4 cm , respectively . At statistical analysis , size result ed as predictor for CA only in G1 ( mean diameter of CA vs non-CA 39.9 vs. 47.7 mm , p = 0.021 ) . During follow-up ( 13.1 and 14.4 months in G1 and G2 ) , mCA occurred in 6/19 ( 32 % ) nodules in G1 , 8/19 ( 42 % ) in G2 . Conclusion MWA and combined therapy are comparable as for safety . No significant differences were found in terms of technique effectiveness . Larger r and omized studies should be design ed to confirm MWA as a valid alternative to combined therapy Purpose : To evaluate the efficacy and safety of microwave ablation combined with transcatheter arterial chemoembolization for unresectable large-sized hepotocellular carcinoma . Material s and methods : Institutional review board approval and informed consent were obtained . Between May 2004 and December 2006 , 34 consecutive patients with large unresectable hepatocellular carcinoma ( > 5 cm ) were alternately enrolled in one of two treatment groups : group 1 ( n = 18 ) , in which TACE was performed alone , and group 2 ( n = 16 ) , in which percutaneous ablation of HCC with microwave ablation was performed 2–4 weeks after TACE . All patients were followed up for 2–28 months to observe long-term therapeutic effects and complications in both groups . Tumor reduction rates , median survival time , and cumulative survival rates in both groups were calculated by using the unpaired Student t test and Kaplan-Meier method . Results : Follow-up images showed reduction in tumor size was seen in 21 patients ( 61.7 % ; 7/18 in group 1 , 14/16 in group 2 ) , survival rates were better in group 2 than in group 1 ( P = 0.003 ) , during the median follow-up of 8 months , 10 patients ( 62.5 % ) remained alive in group 2 , whereas 6 patients ( 33.3 % ) remained alive in group 1 , the mean survival times were 6.13 months ± 0.83 in group 1 and 11.61 months ± 1.59 in group 2 . Conclusion : MWA combined with transcatheter arterial chemoembolization appears to be an effective and promising approach for the treatment of large-sized unresectable hepotocellular carcinoma . However , large-scale r and omized clinical trials are needed to determine the future role of this treatment OBJECTIVE To evaluate the safety and efficacy of transcatheter arterial chemoembolization ( TACE ) combined with percutaneous microwave ablation ( MWA ) in the treatment of advanced hepatocellular carcinoma ( HCC ) . MATERIAL S AND METHODS Three thous and cases of advanced HCC patients were r and omly divided into two groups : 1500 cases in the treatment group were treated with TACE combined with MWA and 1500 cases in the control group were treated with TACE . RESULTS The effective rate of the treatment group and control group was 71.4 % and 42.8 % , respectively , and the difference between the two groups was statistically significant ( P < 0.05 ) . During the follow-up period at 6 , 12 , 18 , and 24 months postoperatively , the survival rates of the treatment group were 88.1 % , 73.8 % , 52.3 % , and 33.3 % , and the survival rates of the control group were 76.2 % , 57.1 % , 30.9 % , and 9.5 % , respectively . There was no significant difference in postoperative complications between the two groups . CONCLUSION It is safe and effective to use TACE combined with MWA in the treatment of advanced HCC , and the effect of combined treatment is better than that of TACE alone Aims To prospect ively assess the use of microwave ablation ( MWA ) to treat hepatocellular carcinoma ( HCC ) with portal vein tumor thrombosis ( PVTT ) after transarterial chemoembolization ( TACE ) , and to evaluate factors that significantly affect treatment outcomes . Methods Sixty patients with HCC [ 55 male , 5 female ; mean age , 54.1 ± 10.2 ( range 36–77 ) years ] + PVTT were enrolled . Patients were treated with MWA after TACE . Results were compared with those of 54 patients treated by TACE alone in another retrospective study . Data analyzed included patient demographics , Eastern Cooperative Oncology Group performance status , liver cirrhosis , liver volume , Child-Pugh class , Cancer of the Liver Italian Program ( CLIP ) score , and imaging findings . Survival time ( from occurrence of PVTT to last follow-up ) and predictive factors and their correlation with survival were statistically evaluated . Results The median 3-year overall survival ( OS ) duration was 13.5 months , and the 1- and 3-year OS rates were 48 and 23 % , respectively . Cox hazards regression analysis revealed that change in the neutrophil-to-lymphocyte ratio , CLIP score , and treatment efficacy were the only independent predictive factors for outcome ( p = 0.035 , 0.024 , and 0.000 , respectively ) . Conclusions Combination therapy with MWA after TACE may provide a substantial benefit for patients with HCC + PVTT type I , II , or partial III and Child-Pugh class A or B by reducing the tumor burden . Trial registration numberChinese Clinical Trial Register ( ChiCTR ) : ChiCTR-ONC-12002689 BACKGROUND AND AIM To evaluate the clinical benefits of transarterial chemoembolization ( TACE ) monotherapy or TACE combined with percutaneous microwave coagulation therapy ( PMCT ) and the long-term survival rate of patients with large primary hepatocellular carcinoma ( HCC ) treated with these techniques . METHODS This is a retrospective study involving 136 patients with unresectable large HCC ( 189 tumor nodules , ≥ 5.0 cm in diameter ) admitted to Sun Yat-Sen University Memorial Hospital ( Guangzhou , China ) between January 2004 and December 2011 . The median follow-up time was 41 months ( range , 6 - 96 months ) . Of these patients , 80 patients received TACE monotherapy and 56 patients received TACE combined with PMCT . The median interval between treatments and overall survival ( OS ) were hierarchically analyzed using log-rank tests . RESULTS All patients successfully underwent TACE alone or TACE with PMCT with no serious complications . The median survival time was 13 months ( range , 3 - 84 months ) for the TACE group and 25 months ( range , 7 - 96 months ) for the TACE-PMCT group . The 1-year , 3-year , and 5-year OS rates were 62.5 % , 17.5 % , and 5.0 % in the TACE group , respectively . In contrast , in the TACE-PMCT group , the 1-year , 3-year , and 5-year OS rates were 87.5 % , 50.0 % , and 10.0 % , respectively . This difference was statistically significant between the groups ( P < 0.001 ) . CONCLUSIONS TACE combined with PMCT had advantages in prolonging OS with satisfying time to progression and improving liver function in patients with large unresectable HCC . The results suggest that further prospect i ve studies are required to confirm the findings of this study BACKGROUND & AIMS Previous prognostic scores for transarterial chemoembolization ( TACE ) were mainly derived from real-world setting s , which are beyond guideline recommendations . A robust model for outcome prediction and risk stratification of recommended TACE c and i date s is lacking . We aim ed to develop an easy-to-use tool specifically for these patients . METHODS Between January 2010 and May 2016 , 1,604 treatment-naïve patients with unresectable hepatocellular carcinoma ( HCC ) , Child-Pugh A5-B7 and performance status 0 undergoing TACE were included from 24 tertiary centres . Patients were r and omly divided into training ( n = 807 ) and validation ( n = 797 ) cohorts . A prognostic model was developed and subsequently vali date d. Predictive performance and discrimination were further evaluated and compared with other prognostic models . RESULTS The final presentation of the model was " linear predictor = largest tumour diameter ( cm ) + tumour number " , which consistently outperformed other currently available models in both training and validation data sets as well as in different subgroups . The thirtieth percentile and the third quartile of the linear predictor , namely 6 and 12 , were further selected as cut-off values , leading to the " six- and -twelve " score which could divide patients into 3 strata with the sum of tumour size and number ≤6 , > 6 but ≤12 , and > 12 presenting significantly different median survival of 49.1 ( 95 % CI 43.7 - 59.4 ) months , 32.0 ( 95 % CI 29.9 - 37.5 ) months , and 15.8 ( 95 % CI 14.1 - 17.7 ) months , respectively . CONCLUSIONS The six- and -twelve score may prove an easy-to-use tool to stratify recommended TACE c and i date s ( Barcelona Clinic Liver Cancer stage-A/B ) and predict individual survival with favourable performance and discrimination . Moreover , the score could stratify these patients in clinical practice as well as help design clinical trials with comparable criteria involving these patients . Further external validation of the score is required . LAY SUMMARY There is currently no prognostic model specifically developed for recommended or ideal transarterial chemoembolization ( TACE ) c and i date s with hepatocellular carcinoma , despite these patients being frequently identified as the best target population in pivotal r and omized controlled trials . The six- and -twelve score provides patient survival prediction , especially in ideal c and i date s of TACE , outperforming other currently available models in both training and validation sets , as well as different subgroups . With cut-off values of 6 and 12 , the score can stratify ideal TACE c and i date s into 3 strata with significantly different outcomes and may shed light on risk stratification of these patients in clinical practice as well as in clinical trials Background Hepatocellular carcinoma ( HCC ) is the fifth most common 
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However , subgroup analysis showed that patients with tumor size > 5 cm were more likely to be benefited from TACE + MWA , rather than patients with tumor size ≤5 cm .
Conclusion : With the current data , we concluded that combination TACE and MWA was safe , and should be strongly recommended to unresectable patients with tumor size > 5 cm , but TACE alone was enough for unresectable patients with tumor size ≤5 cm .