Chen Yizhen, Xu Youyao, Xu Linwei, Han Fang, Huang Yurun, Jiang Hang, Wu Jia, Zhang Yuhua
Department of Hepatobiliary and Pancreatic Surgery, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, China.
Zhejiang Chinese Medical University, Hangzhou, China.
Front Oncol. 2021 Oct 22;11:758552. doi: 10.3389/fonc.2021.758552. eCollection 2021.
Typically, colorectal liver metastasis (CRLM) is not a candidate for hepatectomy. Radiofrequency ablation (RFA) plays a critical role in unresectable CRLM patients. Nevertheless, high local tumor progression (LTP) and distant metastasis limit the development and further adoption and use of RFA. Neoadjuvant chemotherapy (NAC) has been widely used in resectable CRLM and is recommended by the guidelines. There are no studies on whether NAC can improve the prognosis in ablatable CRLM patients. The present study aimed to determine the feasibility and effectiveness of RFA plus NAC.
This retrospective cohort included CRLM patients from Zhejiang Cancer Hospital records, who received RFA from January 2009 to June 2020 and were divided into two groups according to the presence or absence of NAC. The Kaplan-Meier method was used to evaluate the 3-year local tumor progression-free survival (LTPFS), progression-free survival (PFS), and overall survival (OS) of the two groups. The propensity score matching was used to reduce bias when assessing survival. Multivariate Cox proportional hazards regression analysis was used to study the independent factors affecting LTPFS, PFS, and OS.
A total of 149 CRLM patients (88 in the RFA alone group and 61 in the plus NAC group) fulfilled the inclusion criteria. Post-RFA complications were 3.4% in the RFA alone group and 16.4% in the plus NAC group. The 3-year LTPFS, PFS, and OS of the RFA only group were 60.9%, 17.7%, and 46.2%, respectively. The 3-year LTPF, PFS, and OS of the plus NAC group were 84.9%, 46.0%, and 73.6%, respectively. In the 29 pairs of propensity score matching cohorts, the 3-year LTPFS, PFS, and OS in the plus NAC group were longer than those in the RFA group ( < 0.05). NAC was an independent protective factor for LTPFS, PFS, and OS ( < 0.05).
For ablatable CRLM patients, RFA plus NAC obtained a better prognosis than RFA alone. Based on the current results, the application of NAC before RFA may become the standard treatment.
通常情况下，结直肠癌肝转移（CRLM）患者不适合进行肝切除术。射频消融（RFA）在无法切除的CRLM患者中起着关键作用。然而，高局部肿瘤进展（LTP）和远处转移限制了RFA的发展及进一步应用。新辅助化疗（NAC）已广泛应用于可切除的CRLM患者，并且被指南推荐。目前尚无关于NAC能否改善可消融CRLM患者预后的研究。本研究旨在确定RFA联合NAC的可行性和有效性。
本回顾性队列研究纳入了浙江省肿瘤医院记录中的CRLM患者，这些患者在2009年1月至2020年6月期间接受了RFA治疗，并根据是否接受NAC分为两组。采用Kaplan-Meier法评估两组患者的3年局部肿瘤无进展生存期（LTPFS）、无进展生存期（PFS）和总生存期（OS）。在评估生存情况时，采用倾向评分匹配法以减少偏差。采用多变量Cox比例风险回归分析研究影响LTPFS、PFS和OS的独立因素。
共有149例CRLM患者（单纯RFA组88例，联合NAC组61例）符合纳入标准。单纯RFA组RFA术后并发症发生率为3.4%，联合NAC组为16.4%。单纯RFA组的3年LTPFS、PFS和OS分别为60.9%、17.7%和46.2%。联合NAC组的3年LTPF、PFS和OS分别为84.9%、46.0%和73.6%。在29对倾向评分匹配队列中，联合NAC组的3年LTPFS、PFS和OS均长于RFA组（<0.05）。NAC是LTPFS、PFS和OS的独立保护因素（<0.05）。
对于可消融的CRLM患者，RFA联合NAC比单纯RFA预后更好。基于目前的结果，RFA前应用NAC可能成为标准治疗方案。
