Kim Gun Ha, Kim Pyeong Hwa, Kim Jin Hyoung, Kim Pyo-Nyun, Won Hyung Jin, Shin Yong Moon, Choi Sang Hyun
Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Republic of Korea.
Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan, College of Medicine, 86, Asanbyeongwon-gil, Songpa-gu, Seoul, 138-736, Republic of Korea.
Eur Radiol. 2022 Feb;32(2):1205-1215. doi: 10.1007/s00330-021-08216-x. Epub 2021 Aug 4.
To summarize the efficacy and safety of thermal ablation for the treatment of intrahepatic cholangiocarcinoma (ICC).
MEDLINE, EMBASE, Cochran Library, and Web of Science databases were searched for studies reporting outcomes in patients with ICC treated with thermal ablation. Meta-analyses of cumulative overall survival (OS) and recurrence-free survival (RFS), Kaplan-Meier survival rates according to time to local tumor progression (TTLTP), technical efficacy, and incidence of complications were analyzed. Pooled hazard ratios of common variables were calculated to explore factors associated with OS.
Twenty observational studies comprising 917 patients were reviewed (primary ICC [n = 502]; post-surgical recurrent ICC [n = 355]; information not available [n = 60]). The pooled proportion of technical efficacy was 91.9% (95% CI, 87.3-94.9%). The pooled 1-, 3-, and 5-year OS rates were 82.4% (95% CI, 75.1-88.9%), 42.1% (95% CI, 36.0-48.4%), and 28.5% (95% CI, 21.2-36.2%). Primary tumors showed higher 3-year OS rates than recurrent ones, with borderline significance (p = 0.072). The pooled 1- and 3-year RFS rates were 40.0% (95% CI, 33.6-46.4%) and 19.2% (95% CI, 8.4-32.7%). The pooled 1-, 3-, and 5-year TTLTP rates were 79.3% (95% CI, 65.1-90.9%), 59.5% (95% CI, 49.1-69.4%), and 58.2% (95% CI, 44.9-70.9%). The pooled incidence of major complications was 5.7% (95% CI, 4.1-7.8%). Tumor size (> 3 cm), multiple tumors, and age (> 65 years) were factors associated with shorter OS.
Thermal ablation is a successful alternative with a good safety profile, especially for a single ICC smaller than 3 cm.
• The pooled 1-, 3-, and 5-year OS rates following thermal ablation for the treatment of intrahepatic cholangiocarcinoma were 82.4%, 42.1%, and 28.5%. • The pooled incidence of major complications was 5.7%. • A tumor size > 3 cm (HR: 2.12, p = 0.006), multiple tumors (HR: 1.67, p = 0.004), and age > 65 years (HR: 1.67, p = 0.006) were factors associated with shorter OS.
总结热消融治疗肝内胆管癌（ICC）的疗效和安全性。
检索MEDLINE、EMBASE、Cochrane图书馆和Web of Science数据库，查找报告热消融治疗ICC患者结局的研究。分析累积总生存期（OS）和无复发生存期（RFS）的荟萃分析、根据局部肿瘤进展时间（TTLTP）的Kaplan-Meier生存率、技术疗效和并发症发生率。计算常见变量的合并风险比，以探索与OS相关的因素。
回顾了20项观察性研究，共917例患者（原发性ICC [n = 502]；手术后复发性ICC [n = 355]；信息不可用 [n = 60]）。技术疗效的合并比例为91.9%（95%CI，87.3 - 94.9%）。1年、3年和5年的OS合并率分别为82.4%（95%CI，75.1 - 88.9%）、42.1%（95%CI，36.0 - 48.4%）和28.5%（95%CI，21.2 - 36.2%）。原发性肿瘤的3年OS率高于复发性肿瘤，差异具有临界显著性（p = 0.072）。1年和3年的RFS合并率分别为40.0%（95%CI，33.6 - 46.4%）和19.2%（95%CI，8.4 - 32.7%）。1年、3年和5年的TTLTP合并率分别为79.3%（95%CI，65.1 - 90.9%）、59.5%（95%CI，49.1 - 69.4%）和58.2%（95%CI，44.9 - 70.9%）。主要并发症的合并发生率为5.7%（95%CI，4.1 - 7.8%）。肿瘤大小（> 3 cm）、多发肿瘤和年龄（> 65岁）是与较短OS相关的因素。
热消融是一种成功的替代方法，安全性良好，尤其适用于单个直径小于3 cm的ICC。
• 热消融治疗肝内胆管癌后的1年、3年和5年OS合并率分别为82.4%、42.1%和28.5%。• 主要并发症的合并发生率为5.7%。• 肿瘤大小> 3 cm（HR：2.12，p = 0.006）、多发肿瘤（HR：1.67，p = 0.004）和年龄> 65岁（HR：1.67，p = 0.006）是与较短OS相关的因素。
