基于监测、流行病学和最终结果（SEER）数据库的肝内胆管癌射频消融生存结局：与放疗及手术切除的比较
Survival Outcomes of Radiofrequency Ablation for Intrahepatic Cholangiocarcinoma from the Surveillance, Epidemiology, and End Results (SEER) Database: Comparison with Radiotherapy and Resection.
作者信息
Yu Qian, Mahbubani Amar, Kwak Daniel, Liao Chih-Yi, Pillai Anjana, Patel Mikin, Navuluri Rakesh, Funaki Brian, Ahmed Osman
机构信息
Section of Vascular and Interventional Radiology, Department of Radiology, University of Chicago Medical Center, University of Chicago, Chicago, Illinois.
Nova Southeastern University College of Osteopathic Medicine, Davie, Florida.
出版信息
J Vasc Interv Radiol. 2025 Mar;36(3):489-498.e3. doi: 10.1016/j.jvir.2024.10.028. Epub 2024 Nov 2.
PURPOSE
To determine effectiveness of radiofrequency ablation for treatment of intrahepatic cholangiocarcinoma (iCCA) using a population-based database.
MATERIALS AND METHODS
Data were extracted from Surveillance, Epidemiology, and End Results (SEER) database from 2000 to 2020 to include 194 patients who underwent ablation for iCCA. Data on patient demographics, overall survival (OS), and cancer-specific survival were retrieved. Factors associated with survival were evaluated. Comparison between ablation and surgical resection (n = 2,653) or external beam radiotherapy (n = 1,068) was performed.
RESULTS
In the ablation group, patients diagnosed and treated after 2010 demonstrated improved OS than that in the 2000-2009 subgroup (median OS, 32 vs 21 months; hazard ratio, 0.50; 95% CI, 0.33-0.75; P = .001). Additional factors associated with OS included tumor size (≤3 cm vs >3 cm; P = .049) and tumor stage (P < .001). For patients diagnosed after 2010, the 1-, 3-, and 5-year OS were 82.8% (95% CI, 74.8%-88.4%), 43.5% (95% CI, 33.5%-53.1%), and 23.7% (95% CI, 15.3%-33.5%), respectively. Patients with local disease (1-year OS, 87.8%; 95% CI, 78.6%-93.3%) demonstrated improved OS compared with patients with regional (1-year OS, 81.3%; 95% CI, 52.5%-93.5%) and distant disease (50.2%; 95% CI, 34.0%-78.8%; P < .001). For tumors ≤3 cm, ablation and surgical resection offered comparable survival benefits (P = .561), although both were better than radiotherapy (P < .0001).
CONCLUSIONS
Survival of patients with iCCA who underwent thermal ablation has improved over the last 10 years. For tumors ≤3 cm, ablation could be as effective as resection with careful candidate selection, and may be considered front-line compared with radiotherapy in certain patient populations. Patient selection based on tumor size and disease stage could improve survival outcomes.
目的
利用基于人群的数据库确定射频消融治疗肝内胆管癌（iCCA）的有效性。
材料与方法
从监测、流行病学和最终结果（SEER）数据库中提取2000年至2020年的数据，纳入194例行iCCA消融治疗的患者。检索患者人口统计学、总生存期（OS）和癌症特异性生存期的数据。评估与生存相关的因素。对消融与手术切除（n = 2653）或外照射放疗（n = 1068）进行比较。
结果
在消融组中，2010年后诊断和治疗的患者的OS较2000 - 2009亚组有所改善（中位OS，32个月对21个月；风险比，0.50；95%CI，0.33 - 0.75；P = 0.001）。与OS相关的其他因素包括肿瘤大小（≤3 cm对>3 cm；P = 0.049）和肿瘤分期（P < 0.001）。对于2010年后诊断的患者，1年、3年和5年OS分别为82.8%（95%CI，74.8% - 88.4%）、43.5%（95%CI，33.5% - 53.1%）和23.7%（95%CI，15.3% - 33.5%）。局限性疾病患者（1年OS，87.8%；95%CI，78.6% - 93.3%）的OS较区域性疾病患者（1年OS，81.3%；95%CI，52.5% - 93.5%）和远处疾病患者（50.2%；95%CI，34.0% - 78.8%；P < 0.001）有所改善。对于≤3 cm的肿瘤，消融和手术切除提供了相当的生存获益（P = 0.561），尽管两者均优于放疗（P < 0.0001）。
结论
在过去10年中，接受热消融治疗的iCCA患者的生存期有所改善。对于≤3 cm的肿瘤，通过仔细选择合适的患者，消融可能与切除一样有效，并且在某些患者群体中与放疗相比可被视为一线治疗。基于肿瘤大小和疾病分期进行患者选择可改善生存结果。
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