Department of Ultrasound, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, China.
Int J Hyperthermia. 2024;41(1):2323152. doi: 10.1080/02656736.2024.2323152. Epub 2024 Mar 11.
This study was conducted to develop nomograms for predicting repeat intrahepatic recurrence (rIHR) and overall survival (OS), after radiofrequency ablation (RFA), treatment in patients with recurrent colorectal liver metastases (CLMs) after hepatectomy based on clinicopathologic features.
A total of 160 consecutive patients with recurrent CLMs after hepatectomy who were treated with ultrasound-guided percutaneous RFA from 2012 to 2022 were retrospectively included. Patients were randomly divided into a training cohort and a validation cohort, with a ratio of 8:2. Potential prognostic factors associated with rIHR and OS, after RFA, were identified by using the competing-risks and Cox proportional hazard models, respectively, and were used to construct the nomogram. The nomogram was evaluated by Harrell's C-index and a calibration curve.
The 1-, 2-, and 3-year rIHR rates after RFA were 58.8%, 70.2%, and 74.2%, respectively. The 1-, 3- and 5-year OS rates were 96.3%, 60.4%, and 38.5%, respectively. In the multivariate analysis, mutant , interval from hepatectomy to intrahepatic recurrence ≤ 12 months, CEA level >5 ng/ml, and ablation margin <5 mm were the independent predictive factors for rIHR. Mutant , largest CLM at hepatectomy >3 cm, CEA level >5 ng/ml, and extrahepatic disease were independent predictors of poor OS. Two nomograms for rIHR and OS were constructed using the respective significant variables. In both cohorts, the nomogram demonstrated good discrimination and calibration.
The established nomograms can predict individual risk of rIHR and OS after RFA for recurrent CLMs and contribute to improving individualized management.
本研究旨在基于临床病理特征，为肝切除术后复发性结直肠癌肝转移（CLM）患者射频消融（RFA）治疗后预测重复肝内复发（rIHR）和总生存（OS）开发列线图。
回顾性纳入 2012 年至 2022 年期间接受超声引导经皮 RFA 治疗的 160 例肝切除术后复发性 CLM 患者。患者被随机分为训练队列和验证队列，比例为 8:2。使用竞争风险和 Cox 比例风险模型分别确定与 RFA 后 rIHR 和 OS 相关的潜在预后因素，并用于构建列线图。通过 Harrell 的 C 指数和校准曲线评估列线图。
RFA 后 1、2 和 3 年的 rIHR 率分别为 58.8%、70.2%和 74.2%。1、3 和 5 年 OS 率分别为 96.3%、60.4%和 38.5%。多变量分析显示，突变型、肝切除术后至肝内复发的间隔时间≤12 个月、CEA 水平>5ng/ml 和消融边缘<5mm 是 rIHR 的独立预测因素。突变型、肝切除时最大 CLM>3cm、CEA 水平>5ng/ml 和肝外疾病是 OS 不良的独立预测因素。使用各自的显著变量构建了 rIHR 和 OS 的两个列线图。在两个队列中，列线图均表现出良好的区分度和校准度。
所建立的列线图可以预测 RFA 治疗复发性 CLM 后个体 rIHR 和 OS 的风险，有助于改善个体化管理。
