结直肠癌肝转移热消融术后局部肿瘤控制及并发症的相关因素：一项15年回顾性队列研究
Factors Associated With Local Tumor Control and Complications After Thermal Ablation of Colorectal Cancer Liver Metastases: A 15-year Retrospective Cohort Study.
作者信息
Kurilova Ieva, Bendet Achiude, Petre Elena N, Boas Franz E, Kaye Elena, Gonen Mithat, Covey Anne, Brody Lynn A, Brown Karen T, Kemeny Nancy E, Yarmohammadi Hooman, Ziv Etay, D'Angelica Michael I, Kingham T Peter, Cercek Andrea, Solomon Steven B, Beets-Tan Regina G H, Sofocleous Constantinos T
机构信息
Department of Radiology, Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY; Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands; GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands.
Department of Radiology, Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY.
出版信息
Clin Colorectal Cancer. 2021 Jun;20(2):e82-e95. doi: 10.1016/j.clcc.2020.09.005. Epub 2020 Oct 24.
INTRODUCTION
The purpose of this study was to identify risk factors associated with local tumor progression-free survival (LTPFS) and complications after colorectal liver metastases (CLM) thermal ablation (TA).
PATIENTS AND METHODS
This retrospective analysis included 286 patients with 415 CLM undergoing TA (radiofrequency and microwave ablation) in 378 procedures from January 2003 to July 2017. Prior hepatic artery infusion (HAI), bevacizumab, pre-existing biliary dilatation, ablation modality, minimal ablation margin (MM), prior hepatectomy, CLM number, and size were analyzed as factors influencing complications and LTPFS. Statistical analysis included the Kaplan-Meier method, Cox proportional hazards model, competing risk analysis, univariate/multivariate logistic/exact logistic regressions, and the Fisher exact test. Complications were reported according to modified Society of Interventional Radiology guidelines.
RESULTS
The median follow-up was 31 months. There was no LTP for MM > 10 mm. Smaller tumor size, increased MM, and prior hepatectomy correlated with longer LTPFS. The major complications occurred following 28 (7%) of 378 procedures. There were no biliary complications in HAI-naive patients, versus 11% in HAI patients (P < .001), of which 7% were major. Biliary complications predictors in HAI patients included biliary dilatation, bevacizumab, and MM > 10 mm. In HAI patients, ablation with 6 to 10 mm and > 10 mm MM resulted in major biliary complication rates of 4% and 21% (P = .0011), with corresponding LTP rates of 24% and 0% (P = .0033). In HAI-naive patients, the LTP rates for 6 to 10 mm and > 10 mm MM were 27% and 0%, respectively.
CONCLUSIONS
No LTP was seen for MM > 10 mm. Biliary complications occurred only in HAI patients, especially in those with biliary dilatation, bevacizumab, and MM > 10 mm. In HAI patients, MM of 6 to 10 mm resulted in 76% local tumor control and 4% major biliary complications incidence.
引言
本研究旨在确定与结直肠癌肝转移（CLM）热消融（TA）后局部无瘤进展生存期（LTPFS）及并发症相关的危险因素。
患者与方法
本回顾性分析纳入了2003年1月至2017年7月期间接受TA（射频和微波消融）治疗的286例患者的415处CLM，共进行了378次手术。分析了既往肝动脉灌注（HAI）、贝伐单抗、术前存在的胆管扩张、消融方式、最小消融边缘（MM）、既往肝切除术、CLM数量及大小等因素对并发症和LTPFS的影响。统计分析包括Kaplan-Meier法、Cox比例风险模型、竞争风险分析、单因素/多因素逻辑回归/精确逻辑回归以及Fisher精确检验。并发症按照改良的介入放射学会指南进行报告。
结果
中位随访时间为31个月。MM>10 mm时无局部肿瘤进展。肿瘤体积较小、MM增加及既往肝切除术与更长的LTPFS相关。378次手术中有28次（7%）发生了主要并发症。未接受HAI的患者未发生胆系并发症，而接受HAI的患者中胆系并发症发生率为11%（P<.001），其中7%为严重并发症。接受HAI患者胆系并发症的预测因素包括胆管扩张、贝伐单抗及MM>10 mm。在接受HAI的患者中，MM为6至10 mm和>10 mm时，严重胆系并发症发生率分别为4%和21%（P=.0011），相应的局部肿瘤进展率分别为24%和0%（P=.0033）。在未接受HAI的患者中，MM为6至10 mm和>10 mm时的局部肿瘤进展率分别为27%和0%。
结论
MM>10 mm时未见局部肿瘤进展。胆系并发症仅发生在接受HAI的患者中，尤其是存在胆管扩张、使用贝伐单抗及MM>10 mm的患者。在接受HAI的患者中，MM为6至10 mm时局部肿瘤控制率为76%，严重胆系并发症发生率为4%。
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