Survival Outcomes of Microwave Ablation Compared with Repeat Liver Resection in the Treatment of Recurrent Intrahepatic Cholangiocarcinoma
Menée à partir des données d'une étude multicentrique portant sur 494 patients atteints d’un cholangiocarcinome intrahépatique récidivant pour la première fois (âge moyen : 57,8 ans), cette étude analyse la survie globale et la survie sans maladie en fonction du traitement chirurgical (ablation par micro-ondes ou résection hépatique itérative)
Background: Only a minority of patients with recurrent intrahepatic cholangiocarcinoma (iCCA) are eligible for repeat resection. However, whether they benefit from minimally invasive ablation treatment is unclear.
Purpose: To compare the survival outcomes in microwave ablation (MWA) and repeat liver resection (rLR) in the treatment of first recurrent iCCA.
Materials and Methods: In this secondary analysis of a prospective study (Microwave Ablation and Liver Resection for Intrahepatic Cholangiocarcinoma [MALRIC]) from January 2009 to June 2024, participants from 10 hospitals who underwent curative-intent MWA or rLR for recurrent iCCA within Milan-equivalent criteria were identified. One-to-many propensity score matching and overlap weighting were used to balance baseline characteristics. The primary and secondary outcomes were overall survival (OS) and disease-free survival (DFS), respectively. Log-rank test and Cox stratified modeling on matched sets tested survival differences.
Results: MWA (n = 375) or rLR (n = 119) was performed in 494 participants (mean age, 57.8 years ± 10.7 [SD]; 344 men). Compared with rLR, participants who underwent MWA had similar OS (MWA vs rLR median, 29.8 vs 34.0 months, respectively; hazard ratio [HR], 0.89; 95% CI: 0.68, 1.17; P = .31) and DFS (MWA vs rLR median, 10.7 vs 14.8 months; HR, 0.78; 95% CI: 0.61, 1.00; P = .07). RLR showed improved DFS compared with MWA when the primary tumor was the large duct subtype (HR, 0.51; 95% CI: 0.32, 0.91; P = .03); there were no surgical complications after the initial resection (HR, 0.72; 95% CI: 0.52, 0.98; P = .04), and the DFS was less than 12 months (HR, 0.65; 95% CI: 0.46, 0.92; P = .02). Compared with rLR, participants who underwent MWA had shorter hospitalization (median, 9 vs 14 days; P < .001) and fewer complications above Clavien-Dindo grade II (rLR vs MWA, 31.3% vs 5.5%, respectively; P < .001).
Conclusion: Compared with rLR, MWA resulted in similar OS and DFS, and better perioperative outcomes. Clinical trial registration no. NCT06462742
Radiology , article en libre accès, 2026