可切除的复发性结直肠癌肝转移：射频消融能否取代重复的肝转移灶切除术？

Resectable recurrent colorectal liver metastasis: can radiofrequency ablation replace repeated metastasectomy?

作者信息

Mao Rui, Zhao Jian-Jun, Bi Xin-Yu, Zhang Ye-Fan, Han Yue, Li Zhi-Yu, Zhao Hong, Cai Jian-Qiang

机构信息

Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

Department of Interventional Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

出版信息

ANZ J Surg. 2019 Jul;89(7-8):908-913. doi: 10.1111/ans.15080. Epub 2019 May 14.

DOI:10.1111/ans.15080

PMID:31090189

Abstract

BACKGROUND

Percutaneous radiofrequency ablation (RFA) is used as a first-line treatment for colorectal liver metastases that recur after first liver resection in our institution. We aim to evaluate its therapeutic efficacy compared to repeated surgical resection.

METHODS

A retrospective review was performed in 104 patients treated with curative intent for resectable recurrent colorectal liver metastases.

RESULTS

Sixty-one patients underwent RFA and 43 patients underwent surgery. The overall recurrence rates were 82% in the RFA group and 65.1% in the resection group (P = 0.05). The local recurrence rate on a lesion-basis was markedly higher after RFA than that after resection (16.7% versus 7.3%, P = 0.04). The difference remained significant in patients with a maximum lesion diameter >3 cm (24.5% versus 7.6%, P = 0.01). RFA treatment was independently associated with recurrence on multivariate analyses (P = 0.01). 69.7% of RFA patients and 42.6% of surgery patients with intrahepatic recurrence were amenable to repeated local treatment (P = 0.05), leading to the equivalent actuarial 3-year progression free survival rates (RFA: 29.1% versus Resection: 33.1%, P = 0.48) and 5-year overall survival rates in the two treatment groups (RFA: 33% versus Resection: 28.4%, P = 0.36).

CONCLUSIONS

Surgery remains the treatment of choice for resectable recurrence. RFA may offer similar benefit in selected patients.

摘要

背景

在我们机构中，经皮射频消融（RFA）被用作首次肝切除术后复发的结直肠癌肝转移的一线治疗方法。我们旨在评估其与再次手术切除相比的治疗效果。

方法

对104例接受可切除复发性结直肠癌肝转移根治性治疗的患者进行回顾性研究。

结果

61例患者接受了RFA治疗，43例患者接受了手术治疗。RFA组的总复发率为82%，切除组为65.1%（P = 0.05）。基于病灶的局部复发率在RFA治疗后明显高于切除术后（16.7%对7.3%，P = 0.04）。最大病灶直径>3 cm的患者中，这种差异仍然显著（24.5%对7.6%，P = 0.01）。在多因素分析中，RFA治疗与复发独立相关（P = 0.01）。肝内复发的RFA患者中有69.7%和手术患者中有42.6%适合再次局部治疗（P = 0.05），导致两个治疗组的3年无进展生存率相当（RFA：29.1%对切除：33.1%，P = 0.48），5年总生存率也相当（RFA：33%对切除：28.4%，P = 0.36）。