Department of Interventional Ultrasound PLA Medical College The Fifth Medical Center of Chinese PLA General Hospital, Beijing.
Department of Medical Ultrasonics, The Sixth Affiliated Hospital of Sun Yat-Sen University Guangzhou.
Int J Surg. 2024 Jul 1;110(7):4240-4248. doi: 10.1097/JS9.0000000000001397.
Thermal ablation is routinely used for solitary colorectal liver metastases (SCLM), but the added value of adjuvant systemic therapy in SCLM remains unclear. This study aimed to compare the long-term outcomes for SCLM treated by ablation alone (AB) versus ablation plus systemic therapy (AS).
This multicenter retrospective study using nationwide data from fourteen institutions between October 2010 and May 2023, 369 patients with initial SCLM smaller than 5 cm, no extrahepatic metastases, and colorectal cancer R0 resection treated by thermal ablation were included. The crude analysis was used to analyze eligible cases between the two groups. The propensity score matching to control for potential confounders in each matched group. Subgroup analyses were performed to identify specific survival benefits.
61.2% (226/369) of eligible patients were treated with AS and 38.8% (143/369) with AB. During the median follow-up period of 8.8 years, 1-/3-/5-year DFS/OS rates did not differ between the two groups, when analyzed via propensity score matching ( P =0.52/0.08). Subgroup analysis revealed that AS was significantly associated with better OS than AB in patients with plasma CEA >5 ug/l ( P =0.036), T (III-IV) category of primary cancer ( P =0.034), or clinical risk score (1-2) ( P =0.041). In each matched group, the authors did find a significant difference in drug-related adverse events ( P <0.001) between AS group (24.1%, 28/116) and AB group (0.0%, 0/116).
For patients with plasma CEA >5 ug/l, T (III-IV) category of primary cancer, or clinical risk score (1-2), thermal ablation plus systemic therapy appeared to be associated with improved overall survival. Thermal ablation was equally effective in disease-free survival for treating SCLM, whether with or without adjuvant systemic therapy.
热消融术常用于治疗孤立性结直肠癌肝转移（SCLM），但辅助全身治疗在 SCLM 中的附加价值尚不清楚。本研究旨在比较单独消融（AB）与消融联合全身治疗（AS）治疗 SCLM 的长期结果。
本研究使用来自 2010 年 10 月至 2023 年 5 月期间 14 个机构的全国性数据进行多中心回顾性研究，共纳入 369 例初始 SCLM 小于 5cm、无肝外转移和结直肠癌 R0 切除的患者，采用热消融治疗。采用直观分析比较两组合格病例，采用倾向评分匹配控制每组匹配后潜在混杂因素。进行亚组分析以确定特定的生存获益。
61.2%（226/369）的合格患者接受 AS 治疗，38.8%（143/369）接受 AB 治疗。在中位随访 8.8 年期间，通过倾向评分匹配分析，两组患者的 1/3/5 年 DFS/OS 率无差异（P=0.52/0.08）。亚组分析显示，在血浆 CEA>5μg/l（P=0.036）、原发癌 T（III-IV）分期（P=0.034）或临床风险评分（1-2）（P=0.041）的患者中，AS 治疗与 AB 治疗相比，OS 显著改善。在每个匹配组中，作者发现 AS 组（24.1%，28/116）与 AB 组（0.0%，0/116）之间的药物相关不良事件发生率存在显著差异（P<0.001）。
对于血浆 CEA>5μg/l、原发癌 T（III-IV）分期或临床风险评分（1-2）的患者，热消融联合全身治疗似乎与总体生存改善相关。对于治疗 SCLM，无论是否联合辅助全身治疗，热消融在无疾病生存方面均具有相同的疗效。
