Sasaki Kazunari, Margonis Georgios A, Andreatos Nikolaos, Kim Yuhree, Wilson Ana, Gani Faiz, Amini Neda, Pawlik Timothy M
Department of Surgery, The Johns Hopkins Hospital, Baltimore, Maryland.
Department of Surgery, The Johns Hopkins Hospital, Baltimore, Maryland; Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, Wexner Medical Center at the Ohio State University, Columbus, Ohio.
J Surg Res. 2016 Nov;206(1):182-189. doi: 10.1016/j.jss.2016.06.098. Epub 2016 Jul 4.
Combined hepatic resection and radiofrequency ablation (resection-RFA) is a widely accepted multidisciplinary treatment for unresectable colorectal cancer liver metastases. Worse prognosis after resection-RFA is correlated to tumor morphology, although unfavorable morphology is inherent to this patient cohort. This study aimed to select patients who may or may not benefit from resection-RFA with the aid of tumor biology.
Data from 485 patients who underwent curative hepatectomy with or without concurrent RFA were retrospectively collected and analyzed. Clinicopathologic characteristics, predictors of overall survival (OS), and OS of patients stratified by tumor biology in resection-RFA were analyzed.
Combined resection-RFA was performed in 86 patients (17.7%) and a standalone resection in 399 patients. Baseline patients' characteristics of the resection-RFA group were significantly different in terms of median number of tumors (5 versus 2) and bilobar distribution (84.9% versus 29.1%) from those of the resection-only group. Multivariate analysis identified four independent predictors of decreased OS in the resection-RFA group. Three were related to tumor biology: primary tumor nodal metastases (hazard ratio [HR], 2.32; 95% confidence interval (95% CI), 1.16-4.64], Kirsten rat sarcoma viral oncogene homolog mutation (HR, 2.64; 95% CI, 1.36-5.14), and preoperative high carcinoembryonic antigen (HR, 2.33; 95% CI, 1.13-4.81), and one related to tumor morphology-ablated lesions ≥3 (HR, 2.05; 95% CI, 1.41-3.80; P = 0.023). To examine the prognostic influence of tumor biology, the resection-RFA group was stratified into two groups by number of predictors related to tumor biology (low risk: 0-1 risk factors; n = 56 and high risk: 2-3 risk factors; n = 30). Median OS of the low risk, high risk, and resection-alone groups were 61.8, 20.7, and 75.3 mo, respectively. The 5-y OS rate was similar between the low risk and resection-alone group (52.7% versus 58.7%, respectively; P = 0.323).
Patients with low-risk tumors undergoing a combined resection-RFA approach had roughly comparable OS to those who only underwent resection, irrespective of advanced tumor morphology. Combined resection-RFA procedures might be of value to these patients.
肝切除联合射频消融术（切除 - 射频消融术）是一种广泛接受的针对不可切除的结直肠癌肝转移的多学科治疗方法。切除 - 射频消融术后较差的预后与肿瘤形态相关，尽管这种不良形态是该患者群体所固有的。本研究旨在借助肿瘤生物学特性筛选出可能从切除 - 射频消融术中获益或无法获益的患者。
回顾性收集并分析了485例行根治性肝切除术（无论是否同时进行射频消融）患者的数据。分析了临床病理特征、总生存（OS）的预测因素以及按切除 - 射频消融术中肿瘤生物学特性分层的患者的OS。
86例患者（17.7%）接受了联合切除 - 射频消融术，399例患者接受了单纯肝切除术。切除 - 射频消融组患者的基线特征在肿瘤中位数数量（5个对2个）和双叶分布（84.9%对29.1%）方面与单纯切除组有显著差异。多因素分析确定了切除 - 射频消融组中OS降低的四个独立预测因素。其中三个与肿瘤生物学特性有关：原发性肿瘤淋巴结转移（风险比[HR]，2.32；95%置信区间[95%CI]，1.16 - 4.64）、 Kirsten大鼠肉瘤病毒癌基因同源物突变（HR，2.64；95%CI，1.36 - 5.14）以及术前癌胚抗原升高（HR，2.33；95%CI，1.13 - 4.81），另一个与肿瘤形态有关——消融病灶≥3个（HR，2.05；95%CI，1.41 - 3.80；P = 0.023）。为了研究肿瘤生物学特性的预后影响，根据与肿瘤生物学特性相关的预测因素数量将切除 - 射频消融组分为两组（低风险：0 - 1个风险因素；n = 56，高风险：2 - 3个风险因素；n = 30）。低风险组、高风险组和单纯切除组的中位OS分别为61.8个月、20.7个月和75.3个月。低风险组和单纯切除组的5年OS率相似（分别为52.7%和58.7%；P = 0.323）。
接受联合切除 - 射频消融术的低风险肿瘤患者与仅接受肝切除术的患者相比，无论肿瘤形态如何，OS大致相当。联合切除 - 射频消融术对这些患者可能有价值。
