Lin Yuan-Mao, Paolucci Iwan, Albuquerque Marques Silva Jessica, O'Connor Caleb S, Fellman Bryan M, Jones Aaron K, Kuban Joshua D, Huang Steven Y, Metwalli Zeyad A, Brock Kristy K, Odisio Bruno C
From the Departments of Interventional Radiology (Y.-M.L., I.P., J.A.M.S., J.D.K., S.Y.H., Z.A.M., B.C.O.), Imaging Physics (C.S.O., K.A.J., K.K.B.), and Biostatistics (B.M.F.), The University of Texas MD Anderson Cancer Center, Houston, TX.
Invest Radiol. 2024 Apr 1;59(4):314-319. doi: 10.1097/RLI.0000000000001023. Epub 2023 Oct 7.
The aim of this study was to investigate the prognostic value of 3-dimensional minimal ablative margin (MAM) quantified by intraprocedural versus initial follow-up computed tomography (CT) in predicting local tumor progression (LTP) after colorectal liver metastasis (CLM) thermal ablation.
This single-institution, patient-clustered, tumor-based retrospective study included patients undergoing microwave and radiofrequency ablation between 2016 and 2021. Patients without intraprocedural and initial follow-up contrast-enhanced CT, residual tumors, or with follow-up less than 1 year without LTP were excluded. Minimal ablative margin was quantified by a biomechanical deformable image registration method with segmentations of CLMs on intraprocedural preablation CT and ablation zones on intraprocedural postablation and initial follow-up CT. Prognostic value of MAM to predict LTP was tested using area under the curve and competing-risk regression model.
A total of 68 patients (mean age ± standard deviation, 57 ± 12 years; 43 men) with 133 CLMs were included. During a median follow-up of 30.3 months, LTP rate was 17% (22/133). The median volume of ablation zone was 27 mL and 16 mL segmented on intraprocedural and initial follow-up CT, respectively ( P < 0.001), with corresponding median MAM of 4.7 mm and 0 mm, respectively ( P < 0.001). The area under the curve was higher for MAM quantified on intraprocedural CT (0.89; 95% confidence interval [CI], 0.83-0.94) compared with initial follow-up CT (0.66; 95% CI, 0.54-0.76) in predicting 1-year LTP ( P < 0.001). An MAM of 0 mm on intraprocedural CT was an independent predictor of LTP with a subdistribution hazards ratio of 11.9 (95% CI, 4.9-28.9; P < 0.001), compared with 2.4 (95% CI, 0.9-6.0; P = 0.07) on initial follow-up CT.
Ablative margin quantified on intraprocedural CT significantly outperformed initial follow-up CT in predicting LTP and should be used for ablation endpoint assessment.
本研究旨在探讨通过术中与初始随访计算机断层扫描（CT）定量的三维最小消融边缘（MAM）在预测结直肠癌肝转移（CLM）热消融术后局部肿瘤进展（LTP）方面的预后价值。
这项单机构、患者聚类、基于肿瘤的回顾性研究纳入了2016年至2021年间接受微波和射频消融的患者。排除术中及初始随访时未进行对比增强CT检查、存在残留肿瘤或随访时间少于1年且无LTP的患者。采用生物力学可变形图像配准方法，通过术中消融前CT上CLM的分割以及术中消融后和初始随访CT上消融区的分割来定量最小消融边缘。使用曲线下面积和竞争风险回归模型测试MAM预测LTP的预后价值。
共纳入68例患者（平均年龄±标准差，57±12岁；43例男性），有133个CLM。在中位随访30.3个月期间，LTP发生率为17%（22/133）。术中及初始随访CT上分割的消融区中位体积分别为27 mL和16 mL（P<0.001），相应的中位MAM分别为4.7 mm和0 mm（P<0.001）。在预测1年LTP方面，术中CT定量的MAM的曲线下面积（0.89；95%置信区间[CI]，0.83 - 0.94）高于初始随访CT（0.66；95%CI，0.54 - 0.76）（P<0.001）。术中CT上MAM为0 mm是LTP的独立预测因素，亚分布风险比为11.9（95%CI，4.9 - 28.9；P<0.001），而初始随访CT上为2.4（95%CI，0.9 - 6.0；P = 0.07）。
术中CT定量的消融边缘在预测LTP方面显著优于初始随访CT，应用于消融终点评估。
