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Objective: To evaluate the safety and efficacy of percutaneous microwave ablation (MWA) combined with simultaneous transarterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC) patients with microvascular invasion (MVI) or extrahepatic metastases (EHM).Methods: Between August 2012 and April 2017,101 patients with MVI/EHM of HCC underwent percutaneous MWA combined with simultaneous TACE at our center.The clinical data were collected and analyzed for survival and prognostic factors.Results: The mean follow-up time was 23.6 ± 14.7 months.One patient had grade 3 complications,and the median overall survival was 12.0 months (95％ confidence interval 9.7-14.3).Multivariate analysis showed that ChildPugh class,serum alpha-fetoprotein level,and Easte Cooperative Oncology Group performance status were independent factors of survival.Conclusion: Our results suggest that percutaneous MWA combined with simultaneous TACE is a safe and effective treatment for HCC with MVI/EHM.