Machi Junji, Oishi Andrew J, Sumida Kenneth, Sakamoto Kazuhiro, Furumoto Nancy L, Oishi Robert H, Kylstra Jelle W
Department of Surgery and Internal Medicine, University of Hawaii and Kuakini Medical Center, Honolulu, Hawaii 96817, USA.
Cancer J. 2006 Jul-Aug;12(4):318-26. doi: 10.1097/00130404-200607000-00011.
Long-term follow-up data of radiofrequency ablation (RFA) for patients with unresectable metastatic liver tumors from colorectal cancer have rarely been reported. This study was undertaken to evaluate long-term outcome of RFA in relation to its timing opposite chemotherapy, and to identify prognostic factors associated with survival.
Patients undergoing RFA from 1997 to 2003 were monitored. Data were prospectively collected and retrospectively reviewed.
RFA was performed for 100 patients in 146 procedures to ablate 507 colorectal metastatic tumors. All patients were followed up for at least 18 months or until death, up to 84 months: the median follow-up was 24.5 months. The overall median survival was 28 months, and 1-, 3-, and 5-year survival was 90.0%, 42.0%, and 30.5%, respectively. The recurrence-free median survival was 13 months. Median survival was 48 months among 55 patients (55%) who received RFA (first-line) before initiation of chemotherapy, versus 22 months among 45 patients (45%) who received RFA (second-line) for residual or progressive metastatic disease after chemotherapy. Significant factors affecting overall survival were carcinoembryonic antigen level (200 ng/mL), total tumor size (sum diameter of tumors, 100 mm), RFA approach, previous therapeutic chemotherapy by a univariate analysis, age (70 years) by a multivariate analysis, and extrahepatic metastasis by both analyses.
RFA can contribute to encouraging long-term survival. Prognostic factors have been identified. Compared with historical survival, RFA appears to confer a survival benefit over systemic chemotherapy alone, particularly when it is offered as part of first-line therapy.
关于结直肠癌不可切除转移性肝肿瘤患者射频消融（RFA）的长期随访数据鲜有报道。本研究旨在评估RFA相对于化疗时机的长期疗效，并确定与生存相关的预后因素。
对1997年至2003年接受RFA治疗的患者进行监测。前瞻性收集数据并进行回顾性分析。
100例患者接受了146次RFA治疗，共消融507个结直肠转移瘤。所有患者均随访至少18个月或直至死亡，最长随访84个月：中位随访时间为24.5个月。总体中位生存期为28个月，1年、3年和5年生存率分别为90.0%、42.0%和30.5%。无复发生存期的中位时间为13个月。55例（55%）在化疗开始前接受RFA（一线治疗）的患者中位生存期为48个月，而45例（45%）在化疗后因残留或进展性转移性疾病接受RFA（二线治疗）的患者中位生存期为22个月。单因素分析显示，影响总生存的显著因素为癌胚抗原水平（200 ng/mL）、肿瘤总大小（肿瘤直径总和，100 mm）、RFA方式、既往化疗；多因素分析显示年龄（70岁）是影响因素；两种分析均显示肝外转移是影响因素。
RFA有助于提高长期生存率。已确定了预后因素。与既往生存情况相比，RFA似乎比单纯全身化疗更能带来生存获益，尤其是作为一线治疗的一部分时。
