Transarterial chemoembolization versus percutaneous microwave coagulation therapy for recurrent unresectable intrahepatic cholangiocarcinoma: Development of a prognostic nomogram

Yang Ge; Seogsong Jeong; Gui-Juan Luo; Yi-Bin Ren; Bao-Hua Zhang; Yong-Jie Zhang; Feng Shen; Qing-Bao Cheng; Cheng-Jun Sui; Hong-Yang Wang; Qiang Xia; Lei Chen

doi:10.1016/j.hbpd.2020.02.005

Transarterial chemoembolization versus percutaneous microwave coagulation therapy for recurrent unresectable intrahepatic cholangiocarcinoma: Development of a prognostic nomogram

Hepatobiliary Pancreat Dis Int. 2020 Apr;19(2):138-146. doi: 10.1016/j.hbpd.2020.02.005. Epub 2020 Feb 21.

Authors

Yang Ge¹, Seogsong Jeong², Gui-Juan Luo³, Yi-Bin Ren³, Bao-Hua Zhang⁴, Yong-Jie Zhang⁴, Feng Shen⁵, Qing-Bao Cheng⁶, Cheng-Jun Sui⁷, Hong-Yang Wang³, Qiang Xia⁸, Lei Chen⁹

Affiliations

¹ School of Public Health, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China.
² Department of Liver Surgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China; International Co-operation Laboratory on Signal Transduction, Eastern Hepatobiliary Surgery Institute, Second Military Medical University, Shanghai 200438, China.
³ International Co-operation Laboratory on Signal Transduction, Eastern Hepatobiliary Surgery Institute, Second Military Medical University, Shanghai 200438, China; National Center for Liver Cancer, Shanghai 201805, China.
⁴ Biliary Tract Department II, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai 200438, China.
⁵ Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai 200438, China.
⁶ Biliary Tract Department I, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai 200438, China.
⁷ Department of Special Medical Care & Liver Transplantation, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai 200438, China.
⁸ Department of Liver Surgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China.
⁹ International Co-operation Laboratory on Signal Transduction, Eastern Hepatobiliary Surgery Institute, Second Military Medical University, Shanghai 200438, China; Department of Oncology, Shanghai Cancer Center and Institutes of Biomedical Sciences, Shanghai Medical College, Fudan University, Shanghai 200032, China. Electronic address: chenlei@smmu.edu.cn.

PMID: 32139295
DOI: 10.1016/j.hbpd.2020.02.005

Abstract

Background: Transarterial chemoembolization (TACE) and percutaneous microwave coagulation therapy (PMCT) are commonly used to treat intrahepatic recurrent liver cancers. However, there is no information regarding their effectiveness in patients with recurrent intrahepatic cholangiocarcinoma (ICC) after resection.

Methods: A total of 275 patients with localized recurrent ICC who received either TACE (n = 183) or PMCT (n = 92) were studied. A propensity score matching analysis was performed to compare prognostic impact of TACE and PMCT. Prognostic factors for TACE and PMCT were identified respectively. Predictive nomograms for each TACE and PMCT were developed using the Cox independent prognostic factors and were validated in independent patient groups by receiver operating characteristic curves and area under curve values.

Results: Both TACE and PMCT provided curativeness in partial patients (5-year overall survival: 21.4% and 6.1%, respectively), but TACE provided better survival benefit in both overall patients (hazard ratio [HR] = 0.71; 95% confidence interval [CI]: 0.50-0.97; P = 0.034) and propensity score matching analysis (HR = 0.69; 95% CI: 0.47-0.98; P = 0.041). Independent prognostic factors for TACE were tumor size >5 cm, poor differentiation, and major resection, whereas poor differentiation, hepatitis B virus infection, cholelithiasis, and lymph node metastasis were identified for PMCT. Both predictive nomograms for TACE and PMCT were validated to be effective with area under curve values of 0.77 and 0.70, respectively.

Conclusions: TACE provided better survival benefits compared to PMCT. However, there was a disparity in prognostic factors, suggesting evaluation of the two nomograms may be supportive in modality selection. Further prospective validation studies are required for the results to be applied in clinical medicine.

Keywords: Bile duct cancer; Biliary malignancy; Cholangiocarcinoma; Locoregional therapy; Nomogram.

Publication types

Comparative Study
Validation Study

MeSH terms

Adult
Aged
Aged, 80 and over
Animals
Antineoplastic Agents / administration & dosage
Bile Duct Neoplasms / pathology
Bile Duct Neoplasms / surgery
Bile Duct Neoplasms / therapy*
Bile Ducts, Intrahepatic
Blood Coagulation
Chemoembolization, Therapeutic*
Cholangiocarcinoma / secondary
Cholangiocarcinoma / surgery
Cholangiocarcinoma / therapy*
Cholelithiasis / complications
Dogs
Female
Hepatitis, Infectious Canine / complications
Humans
Lymphatic Metastasis
Male
Microwaves / therapeutic use*
Middle Aged
Neoplasm Grading
Neoplasm Recurrence, Local / pathology
Neoplasm Recurrence, Local / therapy*
Nomograms*
Prognosis
Survival Rate
Tumor Burden
Young Adult

Substances

Antineoplastic Agents