Purpose: To evaluate characteristics, including tumor molecular profiling, and outcomes of patients with intrahepatic cholangiocarcinoma (ICC) submitted to percutaneous ablation (PA).
Materials and Methods: This is a three-institution retrospective analysis of 46 patients (28 males) with a total of 69 ICCs (local therapy treatment-naïve at target ICC: 53) submitted to PA (Radiofrequency ablation = 25; Microwave ablation = 39; Irreversible electroporation = 5 ICCs) between 2007 and 2019. Indications included unresectable (12 patients; 15 ICCs), post-radiation (5 patients; 5 ICCs), and post-resection recurrence (29 patients, 49 ICCs). Median tumor diameter was 1.6 cm (range, 0.5-5.1 cm). Outcomes evaluated included local tumor progression-free survival (LTPFS), intra-hepatic progression-free survival (IHPFS), overall survival (OS), and major complications. Recent molecular profiling studies indicate a distinct pattern of somatic mutations in ICC; we explored the impact of these mutations on the clinical outcomes from PA.
Results: 42 patients with a total of 65 ICCs had imaging follow-up (mean 25.7 months, range 0.7-93.6). Primary technical efficacy was 92%. Three-year LTPFS was 71.5 %, mean IHPFS was 15.6 months, and mean OS was 47.1 months for the entire cohort. One major complication (liver abscess) occurred, with no deaths recorded. Somatic mutations were present in 13 (72%) of the 18 patients who received molecular profiling, 6 patients (33%) with a total of 9 ICCs, which possess poor-prognosis mutations (CDKN2A = 3; ARID1A = 2; MSH2 = 1). Three-year LTPFS, mean IHPFS, and mean OS for patients with poor-prognosis mutations were 66.7%, 9.8 months, and 28.8 months, respectively.
Conclusion: PA is an effective loco-regional therapy for small-localized ICC. Larger cohort studies are warranted to evaluate the association between mutational profile and efficacy of liver-directed therapies.