Abstract

Background & aims: Very few data are available in literature about the role of radiofrequency ablation (RFA) in intrahepatic cholangiocarcinoma (ICC) and previous studies are mainly case reports and case series on a very small number of patients and nodules. In this study, we aimed to evaluate effectiveness and safety of RFA for the treatment of unresectable ICC.

Methods: This is a retrospective observational cohort study comprising all consecutive patients treated with RFA for unresectable ICC at Policlinico Sant’Orsola Malpighi Hospital, Bologna, Italy. Primary endpoint was Local Tumor Progression-Free Survival (LTPFS) while Overall Survival (OS) was also assessed as secondary endpoint.

Results: From January 2014 to June 2019, 29 patients with 117 nodules underwent RFA. Technique effectiveness 1 month after RFA was 92.3%; median LTPFS was 9.27 months. Univariate analysis and multivariate analysis showed that LTPFS was significantly related to tumor size ≥20 mm. At a median follow up of 39.9 months, median OS from the date of RFA was 27.5 months, with an OS of 89%, 45% and 11% at 1, 2 and 4 years, respectively. Number of overall lesions and the sum of their diameter at the moment of the first RFA significantly affected OS in multivariate analysis. Minor and major complication rates were 14% and 7%, respectively.

Conclusion: Tumor size ≥20 mm was associated with lower LTPFS, representing a potential useful threshold value. A careful evaluation of tumor burden appears as a crucial element in choosing the best therapeutic strategy in unresectable ICC.

摘要

背景与目的：文献中很少有关于射频消融（RFA）在肝内胆管癌（ICC）中的作用的数据，以前的研究主要是针对极少数患者和结节的病例报告和病例系列。在这项研究中，我们旨在评估RFA治疗不可切除ICC的有效性和安全性。

方法：这是一项回顾性观察性队列研究，包括意大利博洛尼亚Policlinico Sant'Orsola Malpighi医院接受RFA治疗的所有不可切除ICC的连续患者。主要终点为局部无肿瘤进展生存期（LTPFS），而总生存期（OS）也被评估为次要终点。

结果： 2014年1月至2019年6月，对29例117个结节患者进行了RFA。RFA后1个月的技术效率为92.3％；LTPFS的中位数为9.27个月。单因素和多因素分析表明，LTPFS与≥20 mm的肿瘤大小显着相关。在中位随访39.9个月时，自RFA起算的中位OS为27.5个月，分别在1年，2年和4年时OS分别为89％，45％和11％。在多变量分析中，首次RFA时总体病变的数量及其直径的总和显着影响了OS。次要和主要并发症发生率分别为14％和7％。

结论：肿瘤大小≥20 mm与较低的LTPFS相关，代表潜在的有用阈值。仔细评估肿瘤负荷似乎是选择不可切除ICC最佳治疗策略的关键要素。