活检与切缘优化结直肠癌肝转移热消融术后的疗效
Biopsy and Margins Optimize Outcomes after Thermal Ablation of Colorectal Liver Metastases.
作者信息
Vasiniotis Kamarinos Nikiforos, Vakiani Efsevia, Gonen Mithat, Kemeny Nancy E, Sigel Carlie, Saltz Leonard B, Brown Karen T, Covey Anne M, Erinjeri Joseph P, Brody Lynn A, Ziv Etay, Yarmohammadi Hooman, Kunin Henry, Barlas Afsar, Petre Elena N, Kingham Peter T, D'Angelica Michael I, Manova-Todorova Katia, Solomon Stephen B, Sofocleous Constantinos T
机构信息
Interventional Oncology/IR Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA.
Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA.
出版信息
Cancers (Basel). 2022 Jan 29;14(3):693. doi: 10.3390/cancers14030693.
BACKGROUND
Thermal ablation is a definitive local treatment for selected colorectal liver metastases (CLM) that can be ablated with adequate margins. A critical limitation has been local tumor progression (LTP).
METHODS
This prospective, single-group, phase 2 study enrolled patients with CLM < 5 cm in maximum diameter, at a tertiary cancer center between November 2009 and February 2019. Biopsy of the ablation zone center and margin was performed immediately after ablation. Viable tumor in tissue biopsy and ablation margins < 5 mm were assessed as predictors of 12-month LTP.
RESULTS
We enrolled 107 patients with 182 CLMs. Mean tumor size was 2.0 (range, 0.6-4.6) cm. Microwave ablation was used in 51% and radiofrequency ablation in 49% of tumors. The 12- and 24-month cumulative incidence of LTP was 22% (95% confidence interval [CI]: 17, 29) and 29% (95% CI: 23, 36), respectively. LTP at 12 months was 7% (95% CI: 3, 14) for the biopsy tumor-negative ablation zone with margins ≥ 5 mm vs. 63% (95% CI: 35, 85) for the biopsy-positive ablation zone with margins < 5 mm ( < 0.001).
CONCLUSIONS
Biopsy-proven complete tumor ablation with margins of at least 5 mm achieves optimal local tumor control for CLM, regardless of the ablation modality used.
背景
热消融是对部分可实现足够切缘消融的结直肠癌肝转移瘤（CLM）的一种确定性局部治疗方法。一个关键限制是局部肿瘤进展（LTP）。
方法
这项前瞻性单组2期研究于2009年11月至2019年2月在一家三级癌症中心纳入了最大直径<5 cm的CLM患者。消融后立即对消融区中心和边缘进行活检。组织活检中存在存活肿瘤以及消融边缘<5 mm被评估为12个月LTP的预测指标。
结果
我们纳入了107例患者的182个CLM。平均肿瘤大小为2.0（范围0.6 - 4.6）cm。51%的肿瘤使用微波消融，49%使用射频消融。LTP的12个月和24个月累积发生率分别为22%（95%置信区间[CI]：17，29）和29%（95% CI：23，36）。对于边缘≥5 mm的活检肿瘤阴性消融区，12个月时的LTP为7%（95% CI：3，14），而对于边缘<5 mm的活检阳性消融区，LTP为63%（95% CI：35，85）（P<0.001）。
结论
经活检证实的切缘至少5 mm的完全肿瘤消融可实现CLM的最佳局部肿瘤控制，无论使用何种消融方式。
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