Centre Hépato-Biliaire, Assistance Publique - Hôpitaux de Paris, Hôpital Universitaire Paul Brousse, Villejuif, France.
Institut National de la Santé et de la Recherche Médicale (INSERM), Unité 935, Villejuif, France.
Br J Surg. 2017 Apr;104(5):570-579. doi: 10.1002/bjs.10447. Epub 2017 Jan 23.
Combining radiofrequency ablation (RFA) with hepatectomy may enable treatment with curative intent for patients with colorectal liver metastasis (CRLM). However, the oncological outcomes in comparison with resection alone remain to be clarified.
Patients who underwent a first hepatectomy between 2001 and 2012 for CRLM were enrolled. Short- and long-term outcomes of patients who underwent hepatectomy plus RFA were compared with those of patients who had hepatectomy alone using propensity score matching.
Of a total of 553 patients, hepatectomy + RFA and hepatectomy alone were performed in 37 and 516 respectively. Before matching, patients in the hepatectomy + RFA group were characterized primarily by a larger tumour burden. After matching of 31 patients who underwent hepatectomy + RFA with 93 who had hepatectomy alone, background characteristics were well balanced. In the matched cohort, overall and disease-free survival in the hepatectomy + RFA group were no different from those among patients who had hepatectomy alone (5-year overall survival rate 57 versus 61 per cent, P = 0·649; 5-year disease-free survival rate 19 versus 17 per cent, P = 0·865). Local recurrence at the ablated site was observed in four of 31 patients (13 per cent). Although overall local recurrence (ablated site and/or cut surface) was more frequent in the hepatectomy + RFA group (9 of 31 (29 per cent) versus 11 of 93 (12 per cent); P = 0·032), there was no difference in intrahepatic disease-free survival between the two groups (P = 0·705).
Hepatectomy + RFA achieved outcomes comparable to hepatectomy alone. Combining RFA with hepatectomy should be considered as an option to achieve cure.
联合射频消融（RFA）和肝切除术可能为结直肠癌肝转移（CRLM）患者提供治愈性治疗。然而，与单独切除相比，其肿瘤学结果仍需明确。
入组了 2001 年至 2012 年间接受首次肝切除术治疗 CRLM 的患者。采用倾向评分匹配比较行肝切除术联合 RFA 治疗的患者与单纯行肝切除术的患者的短期和长期结局。
在总共 553 例患者中，分别有 37 例和 516 例患者接受了肝切除术+RFA 和单纯肝切除术。在匹配前，肝切除术+RFA 组的患者主要表现为肿瘤负荷较大。在匹配了 31 例接受肝切除术+RFA 的患者和 93 例接受单纯肝切除术的患者后，背景特征得到了很好的平衡。在匹配队列中，肝切除术+RFA 组的总生存和无疾病生存与单纯肝切除术组无差异（5 年总生存率 57%比 61%，P=0.649；5 年无疾病生存率 19%比 17%，P=0.865）。31 例患者中有 4 例（13%）在消融部位出现局部复发。虽然肝切除术+RFA 组的总局部复发（消融部位和/或切缘）更为常见（31 例中有 9 例[29%]，93 例中有 11 例[12%]；P=0.032），但两组的肝内无疾病生存率无差异（P=0.705）。
肝切除术+RFA 达到了与单纯肝切除术相当的结果。联合 RFA 和肝切除术应被视为一种实现治愈的选择。
