Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria.
Department of Radiology, Interventional Oncology-Microinvasive Therapy, Medical University of Innsbruck, Innsbruck, Austria.
PLoS One. 2022 Jan 4;17(1):e0261136. doi: 10.1371/journal.pone.0261136. eCollection 2022.
To evaluate the efficacy, safety and overall clinical outcome of local treatment for recurrent intrahepatic cholangiocellular carcinoma after hepatic resection.
Between 2007 and 2019 72 consecutive patients underwent hepatic resection for primary intrahepatic cholangiocellular carcinoma. If amenable, recurrent tumors were aggressively treated by HR or stereotactic radiofrequency ablation with local curative intent. Endpoints consisted of morbidity and mortality, locoregional and de novo recurrence, disease free survival, and overall survival.
After a median follow-up of 28 months, recurrence of intrahepatic cholangiocellular carcinoma was observed in 43 of 72 patients undergoing hepatic resection (60.3%). 16 patients were subsequently treated by hepatic resection (n = 5) and stereotactic radiofrequency ablation (n = 11) with local curative intention. The remaining 27 patients underwent palliative treatment for first recurrence. Overall survival of patients who underwent repeated aggressive liver-directed therapy was comparable to patients without recurrence (p = 0.938) and was better as compared to patients receiving palliative treatment (p = 0.018). The 5-year overall survival rates for patients without recurrence, the repeated liver-directed treatment group and the palliative treatment group were 54.3%, 47.7% and 12.3%, respectively. By adding stereotactic radiofrequency ablation as an alternative treatment option, the rate of curative re-treatment increased from 11.9% to 37.2%.
Repeated hepatic resection is often precluded due to patient morbidity or anatomical and functional limitations. Due to the application of stereotactic radiofrequency ablation in case of recurrent intrahepatic cholangiocellular carcinoma, the number of patients treated with curative intent can be increased. This leads to favorable clinical outcome as compared to palliative treatment of intrahepatic cholangiocellular carcinoma recurrence.
评估肝切除术后复发性肝内胆管细胞癌局部治疗的疗效、安全性和总体临床结局。
2007 年至 2019 年，72 例连续患者接受了原发性肝内胆管细胞癌的肝切除术。如果可行，复发肿瘤采用 HR 或立体定向射频消融术进行积极治疗，以达到局部治愈的目的。终点包括发病率和死亡率、局部和新发复发、无疾病生存和总生存。
在中位随访 28 个月后，72 例接受肝切除术的患者中有 43 例（60.3%）观察到肝内胆管细胞癌复发。16 例患者随后接受肝切除术（n=5）和立体定向射频消融术（n=11）的局部治愈性治疗。其余 27 例患者接受姑息性治疗以治疗首次复发。接受重复积极肝定向治疗的患者的总生存与无复发患者相当（p=0.938），并且优于接受姑息性治疗的患者（p=0.018）。无复发、重复肝定向治疗组和姑息治疗组的 5 年总生存率分别为 54.3%、47.7%和 12.3%。通过增加立体定向射频消融术作为替代治疗选择，可治愈性再治疗的比例从 11.9%增加到 37.2%。
由于患者的发病率或解剖和功能限制，重复肝切除术通常是不可能的。由于立体定向射频消融术在复发性肝内胆管细胞癌中的应用，可以增加接受治愈性治疗的患者数量。与姑息性治疗肝内胆管细胞癌复发相比，这导致了有利的临床结局。
