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Thermal ablation in the treatment of intrahepatic cholangiocarcinoma: a systematic review and meta-analysis

  • Interventional
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objective

To summarize the efficacy and safety of thermal ablation for the treatment of intrahepatic cholangiocarcinoma (ICC).

Methods

MEDLINE, EMBASE, Cochran Library, and Web of Science databases were searched for studies reporting outcomes in patients with ICC treated with thermal ablation. Meta-analyses of cumulative overall survival (OS) and recurrence-free survival (RFS), Kaplan-Meier survival rates according to time to local tumor progression (TTLTP), technical efficacy, and incidence of complications were analyzed. Pooled hazard ratios of common variables were calculated to explore factors associated with OS.

Results

Twenty observational studies comprising 917 patients were reviewed (primary ICC [n = 502]; post-surgical recurrent ICC [n = 355]; information not available [n = 60]). The pooled proportion of technical efficacy was 91.9% (95% CI, 87.3–94.9%). The pooled 1-, 3-, and 5-year OS rates were 82.4% (95% CI, 75.1–88.9%), 42.1% (95% CI, 36.0–48.4%), and 28.5% (95% CI, 21.2–36.2%). Primary tumors showed higher 3-year OS rates than recurrent ones, with borderline significance (p = 0.072). The pooled 1- and 3-year RFS rates were 40.0% (95% CI, 33.6–46.4%) and 19.2% (95% CI, 8.4–32.7%). The pooled 1-, 3-, and 5-year TTLTP rates were 79.3% (95% CI, 65.1–90.9%), 59.5% (95% CI, 49.1–69.4%), and 58.2% (95% CI, 44.9–70.9%). The pooled incidence of major complications was 5.7% (95% CI, 4.1–7.8%). Tumor size (> 3 cm), multiple tumors, and age (> 65 years) were factors associated with shorter OS.

Conclusion

Thermal ablation is a successful alternative with a good safety profile, especially for a single ICC smaller than 3 cm.

Key Points

• The pooled 1-, 3-, and 5-year OS rates following thermal ablation for the treatment of intrahepatic cholangiocarcinoma were 82.4%, 42.1%, and 28.5%.

• The pooled incidence of major complications was 5.7%.

• A tumor size > 3 cm (HR: 2.12, p = 0.006), multiple tumors (HR: 1.67, p = 0.004), and age > 65 years (HR: 1.67, p = 0.006) were factors associated with shorter OS.

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Abbreviations

CI:

Confidence interval

DFS:

Disease-free survival

HR:

Hazard ratio

ICC:

Intrahepatic cholangiocarcinoma

IQR:

Interquartile range

LTPFS:

Local tumor progression-free survival

MWA:

Microwave ablation

OR:

Odds ratio;

OS:

Overall survival

RFA:

Radiofrequency ablation

RFS:

Recurrence-free survival

TTLTP:

Time to local tumor progression

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The authors state that this work has not received any funding.

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Author notes

  1. Gun Ha Kim and Pyeong Hwa Kim contributed equally to this work and are co-first authors.

Authors and Affiliations

  1. Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Republic of Korea

    Gun Ha Kim, Pyeong Hwa Kim, Jin Hyoung Kim, Pyo-Nyun Kim, Hyung Jin Won, Yong Moon Shin & Sang Hyun Choi

  2. Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan, College of Medicine, 86, Asanbyeongwon-gil, Songpa-gu, Seoul, 138-736, Republic of Korea

    Jin Hyoung Kim

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  1. Gun Ha Kim
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Kim, G.H., Kim, P.H., Kim, J.H. et al. Thermal ablation in the treatment of intrahepatic cholangiocarcinoma: a systematic review and meta-analysis. Eur Radiol 32, 1205–1215 (2022). https://doi.org/10.1007/s00330-021-08216-x

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