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

Figures & data

Figure 1. Flow diagram shows exclusion criteria in patients with recurrent intrahepatic cholangiocarcinoma (RICC). SR = surgical resection, MWA = microwave ablation.

Table 1. Baseline characteristics of patients undergoing MWA and SR.

Characteristic	MWA (n = 56)	SR (n = 65)	p Value
Mean age (y)  ±  SD	54.5  ±  9.3 (30–70)	53.9  ±  17.5 (18–78)	.892^a
Gender			.369^b
Female	7	12
Male	49	53
Comorbid disease			.613^b
No	46	51
Yes	10	14
HBsAg			.981^b
No	32	37
Yes	24	28
Cirrhosis			.707^b
No	38	42
Yes	18	23
KPS	35 (15–70)	60 (40–90)	.014^c
Tumor characteristics
Mean tumor diameter (cm)	2.7 ± 0.5 (0.8–5.0)	2.8 ± 0.4 (1.0–5.0)	.756^a
Tumor no.	50		.822^b
Single	6	57	.785^b
Multiple		8
Pathological differentiation			.885^b
Well/moderately differentiated	42	48
Poorly differentiated	14	17
CA 19-9 (U/ml)			.267^b
≥37	13	21
<37	43	44
Serum ALT (U/L)			.647^b
≥40	11	15
<40	45	50
Serum AST(U/L)			.931^b
≥40	14	17
<40	41	48
ALBI grade			.900^b
1	47	54
2	9	11
Preventive TACE			.791^b
Yes	21	32
No	24	33
Procedure session			.849^b
1	45	55
>1	9	10
Mean total surgical time (min) ± SD	32.5 ± 7.2 (16–42)	109.3 ± 34.5 (55–287)	<.001^a
Median estimated blood loss (ml) ± SD	5.8 (5–22)	81.2 (20–380)	<.001^c
Mean postoperative hospitalization (d) ± SD	4.8 ± 0.5	11.6 ± 2.9	.017^a
Cost (yuan)	24146.6 ± 456.2	29415.5 ± 1203.5	.015^a
LTP	28/56 (50)	33/65 (61.5)	.532^b
Metastasis	11/56 (19.6)	13/65 (20)	.728^b
Technique effectiveness^d^,^e	68/68 (100)	74/74 (100)	ND
Major complications^d^,^e	2/56 (3.6)	2/65 (3.1)	.879^b

Unless otherwise indicated, numbers in parentheses are the range. ND: no data; SD: standard deviation; TACE: transcatheter arterial chemoembolization; LTP: local tumor progression; ALT: alanine aminotransferase; AST: aspartate aminotransferase.

^a Student t-test.

^b Pearson χ² test.

^c Wilcoxon signed rank test.

^d Data in parentheses are percentages.

^e Data are the number of treatments.

Table 2. The changes of liver and renal function before and after treatment in ICC patients.

Parameters	Pre-operative			Post-operative
	SR group	MWA group	p Value	SR group	MWA group	p Value
ALT (U/L)	22.6 ± 9.3	23.2 ± 7.5	.432	221.7 ± 162.1	138.2 ± 53.7	<.001
	(8.7–100.0)	(6.3–104.2)		(16.5–535.4)	(11.2–336.2)
AST (U/L)	31.5 ± 8.7	30.4 ± 8.3	.528	220.0 ± 74.5	175.2 ± 51.3	<.001
	(10.6–40.0)	(11.2–41.3)		(32.0–479.9)	(30.2–372.3)
ALP (U/L)	62.1 ± 5	71.3 ± 4.7	.882	70.7 ± 35.4	65.4 ± 32.7	.231
	(39.4–98.8)	(41.8–94.2)		(19.4–178.9)	(21.2–164.4)
GGT (U/L)	29.6 ± 13.0	32.3 ± 11.2	.218	23.7 ± 11.2	22.3 ± 7.4	.467
	(17.0–91.9)	(18.4–90.2)		(10.7–92.8)	(8.2–75.3)
Cre (umol/L)	63.0 ± 24.8	65.4 ± 22.3	.453	67.2 ± 26.3	41.4 ± 18.5	<.001
	(7.7–109.6)	(7.5–112.4)		(5.9–118.7)	(7.2–125.6)
BUN (mmol/L)	5.2 ± 1.1	4.8 ± 1.3	.382	6.1 ± 4.2	5.3 ± 4.5	.563
	(2.2–7.6)	(2.4–7.2)		(1.2–16.3)	(1.5–19.4)
SA (U/L)	39.3 ± 1.3	34.7 ± 1.7	.921	35.5 ± 1.3	34.2 ± 1.1	.673
	(2.4–7.2)	(3.5–9.3)		(2.4–7.2)	(2.2–6.7)
TB (U/L)	15.8 ± 7.6	15.8 ± 7.6	.172	28.5 ± 15.7	22.6 ± 11.4	<.001
	(7.4–38.6)	(6.8–33.2)		(2.6–44.5)	(3.5–42.7)
DBIL (U/L)	4.3 ± 1.1	4.9 ± 1.4	.228	9.9 ± 8.4	7.6 ± 2.6	.033
	(2.5–26.4)	(2.3–30.3)		(6.0–32.4)	(3.0–30.8)

ALT: alanine aminotransferase; AST: aspartate aminotransferase; ALP: alkaline phosphatase; GGT: gamma-glutamyl transpeptidase; Cre: creatinine; BUN: blood urea nitrogen; SA:Serum Albumin; TB: total bilirubin; DBIL: direct bilirubin.

Figure 2. The cumulative OS and RFS rates of 121 patients undergoing percutaneous microwave ablation and surgical resection for recurrent intrahepatic cholangiocarcinoma after hepatectomy (A). The cumulative OS rate between two groups; (B). The cumulative RFS rate between two groups.

Figure 3. A graph show that the cumulative OS of RICC patients with ALBI grade 1 between microwave ablation group and surgical resection group. B graph show that the cumulative OS of RICC patients with ALBI grade 2 between microwave ablation group and surgical resection group.

Table 3. Univariate analysis of prognostic factors for survival.

	No. of patients	No. of death	χ^2 Value	p Value
Age (years)			3.795	.039*
<65	83	28
≥65	38	20
Gender			0.4	.572
Male	102	44
Female	19	4
Differentiation			0.198	.656
Well/moderately	104	43
Poorly	17	5
Comorbidities			0.057	.811
Yes	107	46
No	24	2
KPS			9.511	.012*
<50	25	14
≥50	96	34
Tumor size (cm)			1.862	.172
<3	89	40
≥3	22	8
Tumor number			0.881	.008*
Single	107	38
Multiple	14	10
Recurrence after initial treatment (month)			0.101	.751
>1 year	76	19
≤1 year	45	29
Etiology			0.557	.455
HBV	52	20
HCV	69	28
LTP			2.105	.147
Present	33	12
Absent	88	36
Extrarenal metastasis			1.118	.026*
Present	12	8
Absent	109	40
Chemoradiation			4.625	.032*
Yes	30	10
No	91	38
CA 19-9 (U/ml)			0.555	.456
≤37	87	40
>37	34	8
ALT level (U/L)			3.712	.425
<40	95	37
≥40	26	11
AST level (U/L)			1.924	.221
<40	99	14
≥40	21	6
Child–Pugh grade			1.111	.605
A	36	17
B	4	3
ALBI grade			2.021	.042*
1	101	35
2	20	13
Major complications			1.635	.635
Present	4	0
Absent	117	48
Treatment modality			2.004	.542
MWA	56	22
SR	65	26

* Univariate Kaplan–Meier analysis.

Table 4. Multivariate analysis of prognostic factors with cox proportional hazards model.

Factors	B	SE	Wald	df	Significance	Exp (B)	95% confidence interval
							Lower	Upper
Sex	−1.286	1.089	1.394	1	0.238	0.276	0.033	2.337
Age	−3.199	1.597	4.013	1	0.145	0.041	0.002	0.933
Tumor diameter	0.29	1.389	0.044	1	0.834	1.337	0.088	20.343
Tumor number	1.525	1.026	2.211	1	0.012	4.595	0.616	34.302
Etiology	0.082	14.612	0	1	0.996	1.085	0.978	2.973
Differentiation	−1.067	1.076	0.983	1	0.322	0.344	0.042	2.836
Comorbidities	1.781	1.089	3.282	1	0.351	7.871	2.871	10.271
KPS	9.581	196.747	0.002	1	0.461	11.892	7.782	23.671
LTP	8.525	196.75	0.002	1	0.165	16.671	7.981	20.781
Metastasis	7.781	34.871	0.065	1	0.016	3.987	2.812	7.982
Child–Pugh classification	6.281	38.289	0.003	1	0.283	7.281	2.563	10.283
ALBI grade	6.329	196.757	0.001	1	0.007	2.367	0.981	3.772
Treatment modality	7.771	196.75	0.001	1	0.882	4.812	1.982	6.298

Bold type indicates statistical significance.