White R R, Avital I, Sofocleous C T, Brown K T, Brody L A, Covey A, Getrajdman G I, Jarnagin W R, Dematteo R P, Fong Y, Blumgart L H, D'Angelica M
Department of Surgical Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
J Gastrointest Surg. 2007 Mar;11(3):256-63. doi: 10.1007/s11605-007-0100-8.
The purpose of this study was to compare rates and patterns of disease progression following percutaneous, image-guided radiofrequency ablation (RFA) and nonanatomic wedge resection for solitary colorectal liver metastases.
We identified 30 patients who underwent nonanatomic wedge resection for solitary liver metastases and 22 patients who underwent percutaneous RFA because of prior major hepatectomy (50%), major medical comorbidities (41%), or relative unresectability (9%). Serial imaging studies were retrospectively reviewed for evidence of local tumor progression.
Patients in the RFA group were more likely to have undergone prior liver resection, to have a disease-free interval greater than 1 year, and to have had an abnormal carcinoembryonic antigen (CEA) level before treatment. Two-year local tumor progression-free survival (PFS) was 88% in the Wedge group and 41% in the RFA group. Two patients in the RFA group underwent re-ablation, and two patients underwent resection to improve the 2-year local tumor disease-free survival to 55%. Approximately 30% of patients in each group presented with distant metastasis as a component of their first recurrence. Median overall survival from the time of resection was 80 months in the Wedge group vs 31 months in the RFA group. However, overall survival from the time of treatment of the colorectal primary was not significantly different between the two groups.
Local tumor progression is common after percutaneous RFA. Surgical resection remains the gold standard treatment for patients who are candidates for resection. For patients who are poor candidates for resection, RFA may help to manage local disease, but close follow-up and retreatment are necessary to achieve optimal results.
本研究的目的是比较经皮影像引导下射频消融（RFA）和非解剖性楔形切除术治疗孤立性结直肠癌肝转移后的疾病进展率和模式。
我们确定了30例行非解剖性楔形切除术治疗孤立性肝转移的患者和22例行经皮RFA的患者，后者是由于先前的大肝切除术（50%）、严重内科合并症（41%）或相对不可切除性（9%）。对系列影像学研究进行回顾性分析，以寻找局部肿瘤进展的证据。
RFA组患者更有可能先前接受过肝切除术，无病间期大于1年，且治疗前癌胚抗原（CEA）水平异常。楔形切除术组的两年局部肿瘤无进展生存率（PFS）为88%，RFA组为41%。RFA组有2例患者接受了再次消融，2例患者接受了切除术，以使两年局部肿瘤无病生存率提高到55%。每组约30%的患者首次复发时出现远处转移。楔形切除术组自切除时起的中位总生存期为80个月，而RFA组为31个月。然而，两组自结直肠癌原发灶治疗时起的总生存期无显著差异。
经皮RFA后局部肿瘤进展很常见。手术切除仍然是适合切除患者的金标准治疗方法。对于不适合切除的患者，RFA可能有助于控制局部疾病，但需要密切随访和再次治疗以获得最佳结果。
