Clinical and survival outcomes of percutaneous microwave ablation for intrahepatic cholangiocarcinoma

Objective: To evaluate the outcomes of percutaneous microwave ablation (MWA) and explore the prognostic factors for the survival of patients with intrahepatic cholangiocarcinoma (ICC).

Methods: A total of 107 patients (age: mean 58.0?years, range 15–85?years) with 171 ICCs (maximum size ≤5?cm, tumour number per patient ≤3) who underwent MWA for ICC during January 2009 to February 2016 were selected, and their clinical and pathological data were collected and reviewed. The MWA-associated mortality, major complication rate and survival were evaluated. The prognostic factors for survival in patients with ICC were analysed with univariate and multivariate analyses.

Results: The median follow-up after MWA was 20.1?months (2.8–63.5?months). There was no procedure-associated death. The overall procedure-associated major complication rate was 2.8%. The median PFS after MWA was 8.9?months; PFS rates after 6, 12, 18 and 24?months were 67.4%, 41.5%, 18.2% and 8.7%. The median OS was 28.0?months; OS rates after 1, 3 and 5?years were 93.5%, 39.6% and 7.9%. Child-Pugh class A and less tumour number were identified as factors predictive of prolonged PFS (HR for Child–Pugh class: 2.62, p?=?0.001; HR for tumour number: 2.07, p?=?0.002) and OS (HR for Child–Pugh class: 4.14, p?p?=?0.024).

Conclusions: Percutaneous ultrasound-guided MWA is safe and effective for ICC. Child–Pugh class A and less tumour number predict prolonged PFS and OS in patients with ICC treated by MWA.     

Ultrasound-guided percutaneous microwave ablation versus surgical resection for recurrent intrahepatic cholangiocarcinoma: intermediate-term results

Objective: The aims of this study were to compare the clinical outcomes between ultrasound-guided percutaneous microwave ablation (US-PMWA) and surgical resection (SR) in patients with recurrent intrahepatic cholangiocarcinoma (ICC) and to identify the prognostic factors associated with the two treatment methods.

Methods: This retrospective study was institutional review board approved. A total of 121 patients (102 men and 19 women) with 136 ICCs after hepatectomy from April 2011 to January 2017 were reviewed. Fifty-six patients underwent US-PMWA and 65 patients underwent SR. Survival, recurrence and liver function were compared between the two groups. Effect of changes in key parameters [i.e., overall survival (OS) and recurrence-free survival (RFS)] was statistically analyzed with the log-rank test. Univariate and multivariate analysis were performed on clinicopathological variables to identify factors affecting long-term outcome.

Results: The OS and RFS after MWA were comparable to that of SR (p?=?.405, and p?=?.589, respectively). Estimated 5-year OS rates were 23.7% after MWA and 21.8% after SR; for RFS, estimated 3-year RFS rates were 33.1% after MWA and 30.6% after SR. Major complication rates in SR group were higher than that in MWA (p?<?.001) (SR, 13.8% vs. MWA, 5.3%). Multivariate analysis showed tumor number (p?=?.012), ALBI grade (p?=?.007), and metastasis (p?=?.016), may become OS rate predictors.

Conclusions: US-PMWA had comparable oncologic outcomes with SR and could be a safe and effective treatment for recurrent ICC after hepatectomy.     

Radiofrequency ablation for postoperative recurrences of intrahepatic cholangiocarcinoma

Objective: Most recurrent intrahepatic cholangiocarcinoma (RICC) lost the opportunity of radical resection while most nonsurgical management failed to prolong patients' survival. The efficacy and safety of radiofrequency ablation (RFA) as a local treatment for recurrent hepatocellular carcinoma have been confirmed by many clinical studies. The purpose of this study was to evaluate the efficacy, long-term survival and complications of RFA for RICC. Methods: A total of 12 patients with 19 RICCs after radical ...     

A model for predicting post-liver transplantation recurrence in intrahepatic cholangiocarcinoma recipients

BackgroundIt is important to select appropriate patients for improving the outcomes of liver transplantation for intrahepatic cholangiocarcinoma (iCCA). The objective of this study was to establish a predictive model for the recurrence of iCCA after liver transplantation.MethodsTwenty-one patients who received liver transplantation for iCCA were used to construct a model for predicting recurrence. Predictors of recurrence were tested by a Cox model analysis. The results were validated in 28 patients who were followed up.ResultsDiameter and number of tumors, and CA19-9 level independently predicted tumor recurrence. At a Cox score threshold of 0.736 [95% confidence interval (CI): 0.549–0.923], a model combining these factors was highly predictive of tumor recurrence and death. A simplified version of the model identified a cut-off value of 6. The 5-year OS rate was lower in patients with a score >6 points compared to those with a score ≤6 points (P=0.005). The 5-year recurrence rate was higher in patients with a score >6 points as compared to those with a score ≤6 points (P=0.034).ConclusionsThe model developed was useful for predicting recurrence of iCCA after liver transplantation. Large sample, multicenter studies are needed to validate the findings.     

肝内胆管细胞癌微创治疗现状及进展#br#

肝内胆管细胞癌(ICC)是一类高侵袭性的恶性肿瘤,远期预后差,手术切除仍是其主要的治疗手段。目前,包括腹腔镜、机器人等在内的微创治疗已越来越广泛地应用于各类患者,其中相当部分是肿瘤患者。近几年国内外部分学者开始尝试应用微创手段治疗ICC患者,但关于其适应证选择及远期疗效尚存争议。该文就腹腔镜、机器人、热消融治疗ICC的研究现状及进展进行了论述。     

CT-guided percutaneous microwave ablation of adrenal malignant carcinoma: preliminary results

BACKGROUND:

Microwave ablation has recently been developed as a safe and effective treatment for a variety of tumors. The authors evaluated the safety and efficacy of computed tomography (CT)‐guided percutaneous microwave ablation of adrenal malignant tumors.

METHODS:

Nine patients between 41 and 83 years of age (average age, 54 years) with adrenal carcinoma (a total of 10 lesions) received CT‐guided percutaneous water‐cooled microwave ablation. The 9 cases included 1 primary adrenocortical carcinoma and 8 metastatic carcinomas (4 from lung cancer, 2 from hepatocellular carcinoma, 1 from intrahepatic cholangiocarcinoma, and 1 from left tibial osteosarcoma). Of the 8 metastatic cases, 7 were unilateral, and 1 was bilateral. All cases were pathologically confirmed by aspiration biopsy or postsurgical biopsy. The tumor diameters ranged from 2.1 cm to 6.1 cm (average, 3.8 cm). The average number of ablation sites was 1.5 sites (1‐3 sites), and the average accumulated ablation time was 7.7 minutes (4‐15 minutes). The procedures were performed using a cooled‐shaft antenna.

RESULTS:

The patients were followed for 3‐37 months, with an average of 11.3 months. Nine of 10 lesions were completely necrotized after first treatment. The other lesion was completely necrotized after 2 treatments. One of the patients experienced hypertensive crisis during treatment. No patient experienced recurrent tumor at the treated site, and this lack of recurrence indicated effective local control. All patients had progression of metastatic disease at extra‐adrenal sites.

CONCLUSIONS:

CT‐guided percutaneous water‐cooled microwave ablation is a minimally invasive and effective method for the treatment of adrenal carcinoma. Cancer 2011;. © 2011 American Cancer Society.     

CT引导经皮穿刺微波消融肺部恶性肿瘤的临床观察

目的 探讨CT引导经皮穿刺微波消融（PMAT）治疗肺部恶性肿瘤的临床疗效及应用价值。方法 2010年3月至2012年10月我科收治的23例周围型肺癌患者行CT引导经皮肺穿刺微波消融治疗,共31个病灶。微波频率2450MHz、功率50～70W,根据肿瘤大小、形状选择1点或2点加热。结果 23例患者均完成治疗,手术时间为5～12 min,平均8min。微波消融后即刻CT表现为病灶密度减低及CT值降低,由术前的均数52.60Hu降低为26.12Hu。获完全缓解6例,部分缓解12例,稳定3例,进展2例,有效率为78.3％。3例气胸,2例胸腔积液,15例发热,无1例针道转移。随访至2012年12月,17例患者存活,1年局部控制率为65.2％,中位无进展生存时间为14.6个月,1年、2年生存率分别为91.3％、82.6％。结论 CT引导下PMAT治疗肺肿瘤微创、安全、有效,可以提高患者的生活质量并延长生存时间。     

Feasible temperature of percutaneous microwave ablation of dog liver abutting the bowel

Purpose: This study used a dog model to determine the optimal temperature of percutaneous microwave ablation that causes complete necrosis of liver but not the adjacent bowel, supporting the use of this method to specifically and effectively treat liver tumour abutting the bowel.

Materials and methods: Ultrasound-guided percutaneous microwave ablation of liver abutting the bowel was performed on healthy adult dogs. Temperature of the ablation margin was monitored and controlled through inserted thermal monitoring needles. Dogs were divided into three groups and received microwave ablation at 75–95°C, 65–75°C, or 55–65°C. Imaging and histological examination were used to evaluate the damage of the bowel adjacent to the ablated liver.

Results: Within one hour of treatment, the bowel adjacent to the ablated liver was seriously burned in the group receiving 75–95°C microwave ablation. Inflammation and congestion were found in the submucosa of the bowel in the group receiving 65–75°C microwave ablation. Minor inflammation was found in the mucosa of the bowel in the group receiving 55–65°C microwave ablation. Moreover, in the group receiving 55–65°C microwave ablation, ablated liver areas were covered with omenta, and histological examination revealed inflammatory reaction of the omenta 28 days after ablation.

Conclusions: Microwave ablation at 55–65°C for 6?min is preferred for ablation of liver tissue abutting the bowel in dogs. These findings may provide some valuable reference for percutaneous microwave ablation of human liver tumour adjacent to the bowel.     

A simple and effective prognostic staging system based on clinicopathologic features of intrahepatic cholangiocarcinoma

Incidence and mortality of intrahepatic cholangiocarcinoma (ICC) are increasing. However, its prognostic predictive system associated with outcome after surgery remains poorly defined. In this study, we conducted retrospective survival analyses in a primary cohort of 370 patients who underwent partial hepatectomy for ICC (2005 and 2009). We found that seven variables were significantly independent predictors for overall survival (OS): serum prealbumin (hazard ratio [HR]: 1.447; p = 0.015), carbohydrate antigen 19-9 (HR: 1.438; p = 0.009), carcinoembryonic antigen (HR: 1.732; p = 0.002), tumor number (HR: 1.781; p < 0.001), vascular invasion (HR: 1.784; p < 0.001), regional lymphatic metastasis (HR: 2.003; p < 0.001) and local extrahepatic metastasis (HR: 1.506; p = 0.008). Using these independent predictors, we created a simple clinicopathologic prognostic staging system for predicting survival of ICC patients after resection. The validity of the prognostic staging system was prospectively assessed in 115 patients who underwent partial hepatectomy between January 2010 and December 2010 at the same institution. The prognostic power was quantified using likelihood ratio test and Akaike information criteria. Compared with the 6^th and 7^th AJCC staging systems, the new staging system in the primary cohort had a higher predictive accuracy for OS in terms of homogeneity and discriminatory ability. In the validation cohort, the homogeneity and discrimination of the new staging system were also superior to the two other staging systems. Conclusions: The new staging system based on clinicopathologic features may provide relatively higher accuracy in prognostic prediction for ICC patients after tumor resection.     

甲磺酸阿帕替尼治疗晚期肝内胆管癌的临床观察

目的观察和评价甲磺酸阿帕替尼治疗晚期肝内胆管癌的疗效和安全性。方法回顾性分析2018年5月至2019年5月接受甲磺酸阿帕替尼治疗的15例晚期肝内胆管癌患者,均口服甲磺酸阿帕替尼(250 mg/日,4周为1个周期),其中一线治疗1例,二线治疗6例,其余为三线及以上治疗。采用RECIST 1.1版和NCI CTC 4.0版标准分别评价近期疗效和不良反应。生存分析采用Kaplan-Meier法。结果随访截止于2019年11月1日,失访1例,13例可评价近期疗效和无进展生存时间(PFS),14例可评价总生存时间(OS)。中位治疗时间为13周。13例患者中获PR 1例,SD 8例,PD 4例;有效率为7.7%,疾病控制率为69.2%;中位PFS为75天,中位OS为294天。主要不良反应包括高血压、手足皮肤反应、口腔溃疡、腹泻和蛋白尿等,以1~2级为主,3级不良反应为2例高血压。结论甲磺酸阿帕替尼治疗晚期肝内胆管癌效果较好,且耐受性良好。     

肝再生磷酸酶-3在肝内胆管癌中的表达及其在肝内胆管癌侵袭转移中的作用

背景与目的探讨肝再生磷酸酶-3(PRL-3)在肝内胆管癌中的表达及其与肝内胆管癌侵袭转移及预后的关系,并进一步研究PRL-3在侵袭转移过程中的作用。     

肝内胆管癌围手术期外周血NLR和PLR对患者预后的预测价值

目的:探讨肝内胆管癌(intrahepatic cholangiocarcinoma,ICCA)围手术期外周血中性粒细胞与淋巴细胞比率(neutrophil-to-lymphocyte ratio,NLR)和血小板与淋巴细胞比率(platelet-to-lymphocyte ratio,PLR)对患者预后的预测价值.方...     

Comparison of percutaneous 915 MHz microwave ablation and 2450 MHz microwave ablation in large hepatocellular carcinoma

Purpose: To compare the effectiveness of ultrasound (US)-guided percutaneous 915 MHz microwave (MW) ablation with the 2450 MHz MW ablation for large hepatocellular carcinoma (HCC) (>4 cm in diameter).

Materials and methods: Patients with HCC >4 cm in diameter who underwent US-guided percutaneous MW ablation with curative intention between March 2007 and December 2008 (39) were randomly divided into two groups, 915 MHz MW group and 2450 MHz MW group. We compared the results of ablation between the two groups.

Results: Fewer antenna insertions for each tumour were required in the 915 MHz MW group (3.69 ± 0.6) than in the 2450 MHz MW group (4.71 ± 1.61) (p = 0.01). According to the follow-up contrast-enhanced imagings, technique effectiveness rate was 85.7% (18/21) and 73.7% (14/19) in the 915 MHz MW group and 2450 MHz MW group, respectively (p = 0.44). The rate of local tumour progression (LTP) was 14.3% (3/21) and 26.3% (5/19) in the 915 MHz MW group and 2450 MHz MW group, respectively (p = 0.44). There were no deaths and no thrombosis of major vessels in any patient.

Conclusions: Compared with 2450 MHz MW ablation, our initial experience showed that percutaneous 915 MHz MW ablation with cooled-shaft antennae was safe and could achieve a high technique effectiveness rate with fewer insertion numbers in the treatment of large HCC. Therefore, percutaneous 915 MHz MW ablation may provide a new method for the treatment of large HCC.     

Meta-analysis on prognostic value of KRAS mutation in resected mass-forming cholangiocarcinoma

BackgroundDespite survival improvements for other cancers, the prognosis of resected mass-forming cholangiocellular carcinoma (MFCCC) remains dismal. As a possible background of that, biologic factors could play some role. KRAS mutation has been investigated in the present systematic review and meta-analysis.MethodsMEDLINE, Embase and Cochrane Library databases were searched for studies reporting overall survival (OS) following liver resection for MFCCC with known KRAS status. Secondary outcomes included completeness of resection (R1 vs R0), pathological lymph node (LN) rate, tumor burden (multiple vs single), perineural invasion (PI) rate.ResultsEight studies comprising 604 patients resected for MFCCC were eligible for analysis. Of these, 23% of patients were mKRAS. The mKRAS MFCCC showed lower 1-year OS [odd ratio (OR) 3.45, 95% confidence interval (CIs) 1.85–6.42; p < 0.001], 3-years OS (OR 4.82, 95% CI 2.63–8.84; p < 0.001), and 5-years OS (OR 10.60, 95% CI 3.12–36.03; p < 0.001) compared to wtKRAS. Pooled-R1 resection rate was 18% for mKRAS and 23% for those with wtKRAS (OR 1.71, 95%CIs 0.70–4.19; p = 0.239). The pooled-pathological LNs rate was 23% in mKRAS vs 17% (OR 2.36, 95%CIs 0.75–7.48; p = 0.144). The pooled-multifocality rate was 55% in mKRAS vs 19% (OR 5.38, 95%CIs 1.76–16.48; p = 0.003), while the pooled-PI was 77% vs 31% (OR 6.59, 95%CIs 2.13–20.37; p = 0.001).ConclusionThe KRAS mutation is relatively frequent in MFCCC. The mKRAS is strongly associated with a shortened survival and higher tumoral aggressiveness. Testing for KRAS mutations could be a valuable adjunct in opening a scenario to new treatments and improving prognosis of patients with MFCCC.     

Diagnosis and cure experience of hepatolithiasis-associated intrahepatic cholangiocarcinoma in 66 patients

Background: The management of hepatolithiasis combined with intrahepatic cholangicarcinoma (IHHCC) remains a challenge due to poor prognosis. The aim of this study was to summarize our diagnosis and cure experience of IHHCC over the recent 10 years. Methods: From January 1996 to January 2006, 66 patients with IHHCC were reviewed retrospectively. Results: Of the 66 patients, 52 underwent surgical resection (radical resection in 38 and palliative in 14) and 8 patients abdominal exploration, while the other 6 cases received endoscopic retrograde biliary internal drainage and stent implantation. In this series, correct diagnosis of advanced stage was made during operation in 8 cases (8/60, 13.3%) and all of them (underwent unnecessary abdominal exploration, among them the positive rate of CA19-9 was 100%, and the positive rate of CEA was 87.6% (7/8), incidence rate of ascites was 100% and short-term significant weight loss was 100%, with median overall survival of only 4 months. Conclusion: Radical resection is mandatory for IHHCC patient to achieve long-term survival, the CT and MR imaging features of IHHCC being concentric enhancement. Patients with IHHCC have significant higher CA199 and significant higher CEA and short-term significant weight loss and ascites should be considered with advanced stage of IHHCC and unnecessary non-therapeutic laparotomies should be avoided.     

A detailed assessment of liver function in patients with hepatocellular carcinoma via the modified albumin-bilirubin (mALBI) grade

Recently, the albumin-bilirubin (ALBI) score, a continuous index consisting of only albumin and bilirubin, has been developed for objectively assessing liver function in patients with hepatocellular carcinoma (HCC). However, the ALBI score was arbitrarily categorized into three ALBI grades based on two artificially predetermined cutoff points with no explanation and statistical grounds, causing a considerable loss of discriminatory ability. This study aims to propose a modified ALBI (mALBI) grade for offering a detailed evaluation of hepatic reserve and specify its role during clinical practice in the HCC setting. The study population comprised 3540 HCC patients treated with mainstream therapies including hepatectomy (n=2056), thermal ablation (n=550), and transcatheter arterial chemoembolization (n=934) from 2002 to 2017. The ALBI score was stratified into four mALBI grades through a recently proposed statistical method aiming to select the optimal cutoff points of a continuous predictive variable by maximizing the discriminative ability in a multivariable Cox regression model. The mALBI grade had an overall better discriminatory ability than the ALBI grade in predicting overall survival through Harrell’s C-index (0.614 vs. 0.598, P<0.001). Both visual inspections of Kaplan-Meier curves and calculation of hazard ratios displayed a more subtle evaluation of liver function using the mALBI grade. Moreover, the newly identified cut-point (ALBI score = -2.29) between the mALBI grade 2a and 2b was much closer to a 30% retention rate of indocyanine green at 15 minutes, an indicator for the performance of a subsegmentectomy. The newly proposed mALBI grade provides a more subtle assessment of liver function to guide clinical decision-making and predicts the prognosis of HCC patients more accurately than the original ALBI grade.     

乙肝病毒蛋白和基因在肝内和肝外胆管癌组织中的检测及意义

目的 研究乙型肝炎病毒(Hepatitis B virus,HBV)感染与胆管癌(Cholangiocarcinoma,CC)的关系,并明确其与肝内胆管癌(Intrahepatic cholangiocarcinoma,ICC)和肝外胆管癌(Extrahepatic cholangiocarcinoma,ECC)发生的关系。方法 采用免疫组化、巢式PCR对52例CC(21例肝内胆管癌和31例肝外胆管癌)石蜡包埋组织进行HBV相关蛋白及基因的检测。结果 21例ICC组织中HBsAg阳性表达率为23.8%(5/21),HBcAg阳性表达率为19.0%(4/21),HBV X 基因检出率为33.3%(7/21)。在31例ECC组织中均未检出HBsAg、HBcAg及HBV X基因。结论 HBV感染与ICC发生关系密切,但可能非ECC发生的危险因素。HBV X基因的整合可能参与肝内胆管上皮细胞的癌变过程。     

Ultrasound-guided percutaneous microwave ablation of adrenal metastasis: Preliminary results

Purpose: To evaluate the feasibility, safety and therapeutic effects of ultrasound (US)-guided percutaneous microwave (MW) ablation in the treatment of adrenal metastasis.

Materials and methods: From May 2006 to April 2008, five consecutive patients with pathologically proven unilateral adrenal metastases with a diameter of 2.3 to 4.5 cm were treated by US-guided percutaneous MW ablation. Four metastases were in the right side, one metastasis was in the left side. For each application, two cooled-shaft needle antennae were percutaneously inserted into the tumour under real-time US guidance. One thermocouple needle was inserted at the periphery of the tumour to monitor temperature in real-time during MW ablation. MW emission was ended when the entire tumour became hyperechoic and the temperature at the tumour border reached 54°C for at least 3 min. Technical success was defined as loss of tumour enhancement on contrast-enhanced imagings.

Results: All adrenal metastases were completely ablated after scheduled MW ablation sessions (mean, 1.2 sessions, range, 1 to 2 sessions). No major complications related to MW ablation occurred. In a median follow-up of 19 months (range 8 to 31 months), persistent absence of tumour enhancement was observed in the treated tumour in all patients.

Conclusions: US-guided percutaneous MW ablation appears to be a safe and effective therapy in selected adrenal metastasis.