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

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.