Humphrey Sophia, Newcomer Jack Bailey, Raissi Driss, Gabriel Gaby
Department of Radiology, University of Kentucky College of Medicine, Lexington, United States.
J Clin Imaging Sci. 2024 Feb 13;14:4. doi: 10.25259/JCIS_59_2023. eCollection 2024.
Cholangiocarcinoma (CCA) is the second-most common primary hepatic malignancy with an increasing incidence over the past two decades. CCA arises from the epithelial cells lining the bile ducts and can be classified as intrahepatic, perihilar, or distal based on the site of origin in the biliary tree. Surgical resection is the definitive curative therapy for early-stage intrahepatic CCA; however, only a minority of patients may be ideal surgical candidates. Percutaneous microwave ablation (MWA) is a minimally invasive procedure widely used for hepatocellular carcinoma and colorectal cancer metastases to the liver. Growing evidence suggests MWA can play a role in the management of patients with early-stage intrahepatic CCA. In this study, we aim to describe the safety and efficacy of MWA for the management of intrahepatic CCA.
A retrospective review of patients with intrahepatic CCA treated with MWA at our tertiary referral medical center was performed. Eight patients were treated between 2014 and 2019. Diagnosis of CCA was made based on histopathological studies of samples obtained by surgical resection or percutaneous liver biopsy. All procedures were performed under computed tomography (CT) guidance using a high-power single antenna MWA system. General anesthesia was used for all procedures. Patient medical history, procedural technical information, outcomes, and follow-up data were reviewed. Progression-free survival was estimated with a Kaplan-Meier curve.
A total of 25 tumors with an average size of 2.2 ± 1.7 cm (range 0.5-7.8) were treated with MWA. Our cohort consisted of eight patients (4 males and 4 females) with an average age of 69.3 ± 5.7 years (range 61-79). Three out of eight (3/8, 37.5%) patients were treated initially with surgical resection. NASH-related cirrhosis was documented in 3/8 (37.5%) patients, while 1/8 (12.5%) had alcoholic cirrhosis; the remaining 4 patients (4/8, 50%) did not have cirrhosis. All patients were discharged within 24 h after ablation. Average total follow-up time was 10.6 ± 11.8 months (range 0-41). The incomplete ablation rate and local recurrence rate were 4% (1/25 lesions) and 12% (3/25 lesions), respectively.
In patients who do not qualify for surgical resection, MWA is a safe alternative therapy for the treatment of intrahepatic CCA.
胆管癌（CCA）是第二常见的原发性肝脏恶性肿瘤，在过去二十年中发病率不断上升。CCA起源于胆管内衬的上皮细胞，根据其在胆管树中的起源部位可分为肝内型、肝门周围型或远端型。手术切除是早期肝内CCA的确定性治愈性疗法；然而，只有少数患者可能是理想的手术候选者。经皮微波消融（MWA）是一种广泛应用于肝细胞癌和结直肠癌肝转移的微创手术。越来越多的证据表明，MWA在早期肝内CCA患者的治疗中可以发挥作用。在本研究中，我们旨在描述MWA治疗肝内CCA的安全性和有效性。
对在我们的三级转诊医疗中心接受MWA治疗的肝内CCA患者进行回顾性研究。2014年至2019年期间共治疗了8例患者。CCA的诊断基于手术切除或经皮肝活检获得的样本的组织病理学研究。所有手术均在计算机断层扫描（CT）引导下使用高功率单天线MWA系统进行。所有手术均采用全身麻醉。回顾了患者的病史、手术技术信息、结果和随访数据。采用Kaplan-Meier曲线估计无进展生存期。
共有25个肿瘤接受了MWA治疗，平均大小为2.2±1.7 cm（范围0.5-7.8 cm）。我们的队列包括8例患者（4例男性和4例女性），平均年龄为69.3±5.7岁（范围61-79岁）。8例患者中有3例（3/8，37.5%）最初接受了手术切除。3/8（37.5%）的患者有非酒精性脂肪性肝炎相关肝硬化，而1/8（12.5%）有酒精性肝硬化；其余4例患者（4/8，50%）没有肝硬化。所有患者在消融后24小时内出院。平均总随访时间为10.6±11.8个月（范围0-41个月）。不完全消融率和局部复发率分别为4%（1/25个病灶）和12%（3/25个病灶）。
对于不适合手术切除的患者，MWA是治疗肝内CCA的一种安全的替代疗法。
