Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands.
Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, the Netherlands.
HPB (Oxford). 2022 Sep;24(9):1443-1452. doi: 10.1016/j.hpb.2022.01.010. Epub 2022 Jan 24.
Regrowth after ablation is common, but predictive factors for local control are scarce. This study investigates whether histopathological growth patterns (HGP) can be used as a predictive biomarker for local control after ablation of colorectal liver metastases (CRLM).
Patients who received simultaneous resection and ablation as first treatment for CRLM between 2000 and 2019 were considered eligible. HGPs were determined on resected CRLM according to international guidelines and were classified as desmoplastic or non-desmoplastic. As minimal inter-tumoural heterogeneity has been demonstrated, the HGP of resected and ablated CRLM were presumed to be identical. Local tumour progression (LTP) was assessed on postoperative surveillance imaging. Uni- and multivariable competing risk methods were used to compare LTP.
In total 221 patients with 443 ablated tumours were analysed. A desmoplastic HGP was found in 60 (27.1%) patients who had a total of 159 (34.7%) ablated lesions. Five-year LTP [95%CI] was significantly higher for ablated CRLM with a presumed non-desmoplastic HGP (37% [30-43] vs 24% [17-32], Gray's-test p = 0.014). On multivariable analysis, a non-desmoplastic HGP (adjusted HR [95%CI]; 1.55 [1.03-2.35]) was independently associated with higher LTP rates after ablation.
HGP is an independent predictor of local tumour progression following ablation of CRLM.
消融后复发很常见，但局部控制的预测因素却很少。本研究探讨了组织病理学生长模式（HGP）是否可以作为消融治疗结直肠肝转移（CRLM）后局部控制的预测生物标志物。
符合条件的患者为 2000 年至 2019 年间接受同时切除和消融作为 CRLM 一线治疗的患者。根据国际指南确定切除的 CRLM 的 HGP，并分为促结缔组织增生型或非促结缔组织增生型。由于已经证明肿瘤之间的最小异质性，因此认为切除和消融的 CRLM 的 HGP 是相同的。术后监测影像评估局部肿瘤进展（LTP）。使用单变量和多变量竞争风险方法比较 LTP。
共分析了 221 例患者的 443 个消融肿瘤。60 例（27.1%）患者存在促结缔组织增生型 HGP，共 159 个（34.7%）消融病变。具有假定非促结缔组织增生型 HGP 的消融 CRLM 的 5 年 LTP [95%CI]明显更高（37%[30-43]比 24%[17-32]，Gray 检验 p=0.014）。多变量分析显示，非促结缔组织增生型 HGP（调整 HR[95%CI]；1.55[1.03-2.35]）与消融后更高的 LTP 率独立相关。
HGP 是消融治疗 CRLM 后局部肿瘤进展的独立预测因子。
