Giorgio Antonio, Gatti Pietro, Montesarchio Luca, Santoro Bruno, Dell'Olio Andrea, Crucinio Nicola, Coppola Carmine, Scarano Ferdinando, Biase Fabio De, Ciracì Emanuela, Semeraro Stefano, Giorgio Valentina
Liver Unit and Interventional Ultrasound Unit, Athena Clinical Institute, Piedimonte Matese (CE), Italy.
Internal Medicine Unit, Brindisi General Hospital, Brindisi, Italy.
J Clin Transl Hepatol. 2019 Dec 28;7(4):287-292. doi: 10.14218/JCTH.2019.00036. Epub 2019 Nov 27.
Despite resection being considered the treatment of choice for intrahepatic cholangiocarcinoma (ICC), percutaneous thermal ablation can be an alternative treatment for patients unfit for surgery. Our aim was to compare long-term results of percutaneous sonographically-guided radiofrequency ablation (RFA) with high-powered microwave ablation (MWSA) in treatment of ICC. Results of 71 ICC patients with 98 nodules treated with RFA (36 patients) or MWSA (35 patients) between January 2008 and June 2018 in 5 Interventional Ultrasound centers of Southern Italy were retrospectively reviewed. Cumulative overall survival curves were calculated with the Kaplan-Meyer method and differences with the log-rank test. Eleven possible factors affecting survival were analyzed. Overall survival of the entire series was 88%, 65%, 45% and 34% at 12, 36, 60 and 80 months, respectively. Patients treated with MWSA survived longer than patients treated with RFA ( < 0.005). The MWSA group with ICC nodules ≤3 cm or nodules up to 4 cm survived longer than the RFA group ( < 0.0005). In patients with nodules >4 cm, no significant difference was found. Disease-free survival and progression-free survival were better in the MWSA group compared to the RFA group ( < 0.005). Diameter of nodules and MWSA were independent factors predicting a better survival. No major complications were observed. MWSA is superior to RFA in treating ICC unfit for surgery, achieving better long-term survival in small (≤3 cm) ICC nodules as well as nodules up to 4 cm of neoplastic tumors and should replace RFA.
尽管肝内胆管癌（ICC）的治疗首选是手术切除，但对于不适合手术的患者，经皮热消融可作为一种替代治疗方法。我们的目的是比较经皮超声引导下射频消融（RFA）与高功率微波消融（MWSA）治疗ICC的长期效果。回顾性分析了2008年1月至2018年6月期间在意大利南部5个介入超声中心接受RFA（36例患者）或MWSA（35例患者）治疗的71例ICC患者、98个结节的结果。采用Kaplan-Meier法计算累积总生存曲线，并通过对数秩检验分析差异。分析了11个可能影响生存的因素。整个系列的12个月、36个月、60个月和80个月总生存率分别为88%、65%、45%和34%。接受MWSA治疗的患者比接受RFA治疗的患者生存时间更长（P<0.005）。ICC结节≤3 cm或结节最大达4 cm的MWSA组比RFA组生存时间更长（P<0.0005）。在结节>4 cm的患者中，未发现显著差异。MWSA组的无病生存率和无进展生存率优于RFA组（P<0.005）。结节直径和MWSA是预测更好生存的独立因素。未观察到重大并发症。在治疗不适合手术的ICC方面，MWSA优于RFA，在小（≤3 cm）ICC结节以及肿瘤最大达4 cm的结节中能实现更好的长期生存，应取代RFA。
