Khajanchee Yashodhan S, Hammill Chet W, Cassera Maria A, Wolf Ronald F, Hansen Paul D
Hepatobiliary and Pancreatic Surgery Program, Providence Portland Medical Center, 4805 NE Glisan St, Ste 6N50, Portland, OR 97213, USA.
Arch Surg. 2011 Dec;146(12):1416-23. doi: 10.1001/archsurg.2011.212.
Current literature evaluating radiofrequency ablation (RFA) for treatment of colorectal liver metastases describes high-risk surgical candidates or patients with unresectable disease. This creates bias when comparing RFA and hepatic resection. A Markov analysis would define theoretical outcomes necessary for RFA to demonstrate equivalence to resection.
A multistate Markov decision analytic model was constructed. Second-order Monte Carlo analysis was used to simulate a randomized controlled trial. Sensitivity analyses were performed to determine the projected outcomes necessary for RFA to achieve equivalence with resection.
Tertiary care teaching hospital.
A systematic review of published literature was performed, identifying studies involving patients with colorectal liver metastases treated with RFA or resection. Data were also included from a prospective database of patients undergoing laparoscopic RFA at our institution.
Percutaneous or laparoscopic RFA and hepatic resection.
Quality-adjusted life expectancy and quality of life-adjusted survival.
The base-case analysis (60-year-old man) demonstrated a mean ± SD quality-adjusted life expectancy of 5.67 ± 0.71 years and a 5-year survival of 38.2% following resection. Based on current literature, the mean ± SD quality-adjusted life expectancy for RFA was 3.61 ± 0.49 years, with a 5-year survival of 27.2%. Sensitivity analyses demonstrated that RFA becomes the preferred strategy if the median disease-free survival reaches 1.42 years. When limited to patients from our institution with resectable lesions, the quality-adjusted life expectancy for RFA improved to a mean ± SD of 5.72 ± 0.50 years.
Classical Markov analysis demonstrates that based on current literature, resection is superior to RFA in the treatment of colorectal liver metastases. When input is limited to laparoscopic RFA in patients with resectable lesions, projected 5-year survival is superior to that of hepatic resection.
目前评估射频消融（RFA）治疗结直肠癌肝转移的文献描述的是高风险手术候选者或不可切除疾病的患者。这在比较RFA和肝切除时会产生偏差。马尔可夫分析将定义RFA证明与切除等效所需的理论结果。
构建了一个多状态马尔可夫决策分析模型。使用二阶蒙特卡罗分析来模拟一项随机对照试验。进行敏感性分析以确定RFA实现与切除等效所需的预期结果。
三级护理教学医院。
对已发表文献进行系统综述，确定涉及接受RFA或切除治疗的结直肠癌肝转移患者的研究。数据还包括来自我们机构接受腹腔镜RFA患者的前瞻性数据库。
经皮或腹腔镜RFA以及肝切除。
质量调整生命预期和生活质量调整生存。
基础病例分析（60岁男性）显示，切除术后平均±标准差质量调整生命预期为5.67±0.71年，5年生存率为38.2%。根据当前文献，RFA的平均±标准差质量调整生命预期为3.61±0.49年，5年生存率为27.2%。敏感性分析表明，如果无病生存期中位数达到1.42年，RFA将成为首选策略。当仅限于我们机构有可切除病变的患者时，RFA的质量调整生命预期提高到平均±标准差为5.72±0.50年。
经典马尔可夫分析表明，根据当前文献，在治疗结直肠癌肝转移方面，切除优于RFA。当输入仅限于有可切除病变患者的腹腔镜RFA时，预计5年生存率优于肝切除。
