Radiology Institute, Department of Surgical Sciences, University of Turin, Città della Salute e della Scienza, Via Genova 3, 10126, Torino, Italy.
Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, Texas, USA.
Eur Radiol. 2018 Jul;28(7):2727-2734. doi: 10.1007/s00330-017-5273-2. Epub 2018 Feb 7.
To investigate effects of ablation margins on local tumour progression-free survival (LTPFS) according to RAS status in patients with colorectal liver metastases (CLM).
This two-institution retrospective study from 2005-2016 included 136 patients (91 male, median age 60 years) with 218 ablated CLM. LTPFS was performed using the Kaplan-Meier method and evaluated with the log-rank test. Uni/multivariate analyses were performed using Cox-regression models.
Three-year LTPFS rates for CLM with minimal ablation margin ≤10 mm were significantly worse than those with >10 mm in both mutant-RAS (29% vs. 48%, p=0.038) and wild-type RAS (70% vs. 94%, p=0.039) subgroups. Three-year LTPFS rates of mutant-RAS were significantly worse than wild-type RAS in both CLM subgroups with minimal ablation margin ≤10 mm (29% vs. 70%, p<0.001) and >10 mm (48% vs. 94%, p=0.006). Predictors of worse LTPFS were ablation margins ≤10 mm (HR: 2.17, 95% CI 1.2-4.1, p=0.007), CLM size ≥2 cm (1.80, 1.1-2.8, p=0.017) and mutant-RAS (2.85, 1.7-4.6, p<0.001).
Minimal ablation margin and RAS status interact as independent predictors of LTPFS following CLM ablation. While minimal ablation margins >10 mm should be always the procedural goal, this becomes especially critical for mutant-RAS CLM.
• RAS and ablation margins are predictors of local tumour progression-free survival. • Ablation margin >10 mm, always desirable, is crucial for mutant RAS metastases. • Interventional radiologists should be aware of RAS status to optimize LTPFS.
根据 RAS 状态，研究结直肠癌肝转移（CLM）患者的消融边缘对局部肿瘤无进展生存期（LTPFS）的影响。
本项回顾性研究来自 2005 年至 2016 年的 2 个机构，共纳入了 136 名（91 名男性，中位年龄 60 岁）接受 218 个 CLM 消融治疗的患者。使用 Kaplan-Meier 法进行 LTPFS 分析，并采用对数秩检验进行评估。使用 Cox 回归模型进行单因素和多因素分析。
在 RAS 突变和野生型患者中，消融边缘最小 10mm 时的 3 年 LTPFS 率明显低于>10mm（29%比 48%，p=0.038；70%比 94%，p=0.039）。在最小消融边缘最小 10mm 时，RAS 突变亚组的 3 年 LTPFS 率明显低于野生型（29%比 70%，p<0.001）；在>10mm 时，RAS 突变亚组的 3 年 LTPFS 率明显低于野生型（48%比 94%，p=0.006）。较差的 LTPFS 的预测因子为消融边缘≤10mm（HR：2.17，95%CI 1.2-4.1，p=0.007）、CLM 直径≥2cm（1.80，1.1-2.8，p=0.017）和 RAS 突变（2.85，1.7-4.6，p<0.001）。
最小消融边缘和 RAS 状态作为 CLM 消融后 LTPFS 的独立预测因子相互作用。虽然消融边缘>10mm 应该始终是手术的目标，但对于 RAS 突变的 CLM 尤其重要。
• RAS 和消融边缘是局部肿瘤无进展生存期的预测因子。
• 消融边缘>10mm，理想情况下，对于 RAS 突变的转移灶至关重要。
• 介入放射科医生应了解 RAS 状态，以优化 LTPFS。
