Interventional Radiology Unit, Hôpital Avicenne, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance Publique Hôpitaux de Paris, Bobigny, France.
Liver Unit, Hôpital Avicenne, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance Publique Hôpitaux de Paris, Bobigny, France.
Eur Radiol. 2024 Sep;34(9):5529-5540. doi: 10.1007/s00330-024-10617-7. Epub 2024 Feb 9.
This study aimed to evaluate the incidence and clinical implications of bile duct changes following multibipolar radiofrequency ablation (mbpRFA) for hepatocellular carcinoma (HCC).
Radiological, clinical, and biological data from consecutive cirrhotic patients who underwent first-line mbpRFA between 2007 and 2014 for uninodular HCC ≤ 5 cm were retrospectively collected. Follow-up imaging was reviewed to identify bile duct changes and factors associated with biliary changes were assessed using multivariable analysis. Baseline and 6-month liver function tests were compared in patients with and without bile duct changes. Complications, cirrhosis decompensation, and survival rates were compared in both groups.
A total of 231 patients (mean age 68 years [39-85], 187 men) underwent 266 mbpRFA sessions for uninodular HCC (mean size 26 mm). Of these, 76 (33%) developed bile duct changes (upstream bile duct dilatations and/or bilomas) with a mean onset time of 3 months. Identified risk factors for these changes were the infiltrative aspect of the tumor (p = 0.035) and its location in segment VIII (p < 0.01). The average increase in bilirubin at 6 months was higher in the group with biliary changes (+2.9 vs. +0.4 µg/mL; p = 0.03). There were no significant differences in terms of complications, cirrhosis decompensation at 1 year (p = 0.95), local and distant tumor progression (p = 0.91 and 0.14 respectively), and overall survival (p = 0.4) between the two groups.
Bile duct changes are common after mbpRFA for HCC, especially in tumors with an infiltrative aspect or those located in segment VIII. These changes do not appear to negatively impact the course of cirrhosis at 1 year or overall survival.
Bile duct changes following mbpRFA for HCC are relatively common. Nevertheless, they do not raise clinical concerns in terms of complications, deterioration in liver function, or survival rates. Consequently, specific monitoring or interventions for these bile duct changes are not warranted.
• Bile duct changes are frequently observed after multibipolar radiofrequency ablation for hepatocellular carcinoma, occurring in 33% of cases in our study. • Patients with bile duct changes exhibited a higher increase in bilirubin levels at 6 months but no more cirrhosis decompensation or liver abscesses. • Biliary changes following multibipolar radiofrequency ablation for hepatocellular carcinoma are not alarming and do not necessitate any specific monitoring or intervention.
本研究旨在评估多极射频消融（mbpRFA）治疗肝细胞癌（HCC）后胆管变化的发生率和临床意义。
回顾性收集 2007 年至 2014 年间因单发直径≤5cm 的不可切除 HCC 行一线 mbpRFA 的连续肝硬化患者的影像学、临床和生物学资料。回顾性分析随访影像学检查以确定胆管变化，并使用多变量分析评估与胆管变化相关的因素。比较胆管变化组和无胆管变化组患者的基线和 6 个月肝功能检查结果。比较两组患者的并发症、肝功能失代偿和生存率。
共 231 例患者（平均年龄 68 岁[39-85]，187 例男性）接受了 266 次用于单发 HCC（平均大小 26mm）的 mbpRFA 治疗。其中 76 例（33%）出现胆管变化（上游胆管扩张和/或胆汁瘤），平均发病时间为 3 个月。肿瘤的浸润性表现（p=0.035）和位于 VIII 段（p<0.01）是这些变化的识别风险因素。胆管变化组 6 个月时胆红素平均升高（+2.9 vs.+0.4μg/mL；p=0.03）。两组间并发症、1 年时肝功能失代偿（p=0.95）、局部和远处肿瘤进展（p=0.91 和 0.14）以及总生存率（p=0.4）差异均无统计学意义。
mbpRFA 治疗 HCC 后胆管变化较为常见，尤其是浸润性肿瘤或位于 VIII 段的肿瘤。这些变化似乎不会对 1 年内肝功能失代偿或总体生存率产生负面影响。
HCC 患者行 mbpRFA 后胆管变化较为常见，但在并发症、肝功能恶化或生存率方面并未引起临床关注。因此，不需要对这些胆管变化进行特定的监测或干预。
在本研究中，多极射频消融治疗肝细胞癌后，胆管变化的发生率为 33%。
胆管变化组患者在 6 个月时胆红素水平升高更为明显，但肝功能失代偿或肝脓肿发生率无增加。
多极射频消融治疗肝细胞癌后出现的胆管变化并不令人担忧，也不需要任何特定的监测或干预。
