Efficacy and safety of computed tomography-guided coablation for hepatic malignancies

doi:10.4251/wjgo.v18.i8.121533

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World Journal of Gastrointestinal Oncology

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1948-5204

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Gastrointest Oncol. Aug 15, 2026; 18(8): 121533
Published online Aug 15, 2026. doi: 10.4251/wjgo.v18.i8.121533

Efficacy and safety of computed tomography-guided coablation for hepatic malignancies

Bao-Jiang Liu, Fu-Xin Kou, Jian-Hai Guo, Di Wu, Xin Zhang, Ai-Wei Feng, Xiao-Dong Wang, Guang Cao, Liang Xu, Hui Chen, Peng Liu, Hai-Feng Xu, Qin-Zong Gao, Ren-Jie Yang, Song Gao, Xu Zhu

Bao-Jiang Liu, Fu-Xin Kou, Jian-Hai Guo, Di Wu, Xin Zhang, Ai-Wei Feng, Xiao-Dong Wang, Guang Cao, Liang Xu, Hui Chen, Peng Liu, Hai-Feng Xu, Qin-Zong Gao, Ren-Jie Yang, Song Gao, Xu Zhu, Department of Interventional Therapy, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing 100142, China

Co-first authors: Bao-Jiang Liu and Fu-Xin Kou.

Co-corresponding authors: Song Gao and Xu Zhu.

Author contributions: Liu BJ, Kou FX contributed equally to this work and they are co-first authors; Zhu X and Gao S designed and supervised the study, revised the manuscript and they are co-corresponding authors; Liu BJ, Kou FX, Guo JH, Wu D, and Zhang X contributed to clinical procedures and data collection; Feng AW, Wang XD, Cao G, Xu L, Chen H, and Liu P contributed to imaging evaluation and data analysis; Xu HF, Gao QZ, and Yang RJ contributed to statistical analysis; Liu BJ, Kou FX, and Guo JH drafted the manuscript; all the authors approved the final version.

AI contribution statement: We only used AI tools to help with polishing the English in our response letter. All the scientific content, our replies to the reviewers, data interpretation, and revisions were done and double-checked by us authors. We also went through the entire document again before resubmitting.

Supported by the Beijing Health Technologies Promotion Program, No. BHTPP2024; the Beijing Hospitals Authority’s Ascent Plan, No. DFL20220903; and the National Key RD Program of China, No. 2023YFC2414001.

Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of the Beijing Cancer Hospital (approval No. 2018KT59).

Clinical trial registration statement: The clinical trial is registered in the Chinese Clinical Trial Registry (Registration ID: ChiCTR1800016952).

Informed consent statement: All study participants, or their legal guardians, provided written consent prior to study enrollment.

Conflict-of-interest statement: The authors declare that they have no conflict of interest.

CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.

Data sharing statement: No additional data are available.

Corresponding author: Xu Zhu, MD, Doctor, Department of Interventional Therapy, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, No. 52 Fucheng Road, Haidian District, Beijing 100142, China. drzhuxu@163.com

Received: March 30, 2026
Revised: April 17, 2026
Accepted: May 11, 2026
Published online: August 15, 2026
Processing time: 131 Days and 1.7 Hours

Abstract

BACKGROUND

Coablation, which combines cryoablation and thermal ablation within a single probe, has emerged as a novel locoregional therapy for hepatic malignancies. However, prospective clinical evidence regarding its efficacy and safety remains limited.

AIM

To investigate the efficacy and safety of computed tomography (CT)-guided coablation in patients with hepatic malignancies in a prospective single-arm study.

METHODS

In this prospective, single-arm study, patients with hepatic malignancies underwent CT-guided coablation. The primary outcomes were safety and local tumor progression (LTP), and the secondary outcome was progression-free survival (PFS). Subgroup analyses were performed to evaluate the factors that influence clinical outcomes.

RESULTS

A total of 71 patients with 88 focal liver lesions (mean size: 4.2 ± 2.0 cm) underwent coablation. Among these patients, 55, 15, and 1 had one, two, and three targeted lesions, respectively. The median follow-up period was 12 months. The cumulative LTP rates at 3, 6, and 12 months were 0%, 1.4%, and 5.6%, respectively. An ice ball-to-lesion maximum cross-sectional area ratio ≥ 1 was associated with a significantly lower incidence of LTP than a ratio < 1 was [hazard ratio (HR) = 0.036; 95% confidence interval (CI): 0.003-0.391; P = 0.006]. The PFS rates at 3, 6, and 12 months were 100%, 98.6%, and 88.7%, respectively. Univariate and multivariate Cox regression analyses revealed an Eastern Cooperative Oncology Group performance status of 0 (HR = 0.094; 95%CI: 0.016-0.549; P = 0.008) and an ice ball area-to-lesion maximum cross-sectional area ratio ≥ 1 (HR = 0.079; 95%CI: 0.013-0.490; P = 0.006) as independent predictors of improved PFS. The primary treatment-emergent adverse events (TEAEs) were subcapsular hepatic hematoma (8.2%) and postoperative fever (4.1%). No serious TEAEs were reported.

CONCLUSION

CT-guided coablation appears to be a safe and effective treatment modality for hepatic malignancies, providing favorable local tumor control and short-term PFS, particularly for patients with tumors located in high-risk anatomical regions.

Keywords: Coablation; Cryoablation; Thermal ablation; Computed tomography-guided; Hepatic malignancies; Local tumor progression; Progression-free survival

Core Tip: This prospective study suggests that computed tomography-guided coablation, which involves the integration of cryoablation and thermal ablation through a single probe, is a safe and effective treatment modality for hepatic malignancies and provides favorable local tumor control with minimal complications. Notably, an ice ball-to-lesion area ratio ≥ 1 may serve as an independent predictor of improved outcomes, particularly for tumors in high-risk locations.