Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Department of Radiology, Interventional Oncology/Stereotaxy and Robotics, Medical University of Innsbruck, Innsbruck, Austria.
Br J Surg. 2024 Aug 30;111(9). doi: 10.1093/bjs/znae165.
Several ablation confirmation software methods for minimum ablative margin assessment have recently been developed to improve local outcomes for patients undergoing thermal ablation of colorectal liver metastases. Previous assessments were limited to single institutions mostly at the place of development. The aim of this study was to validate the previously identified 5 mm minimum ablative margin (A0) using autosegmentation and biomechanical deformable image registration in a multi-institutional setting.
This was a multicentre, retrospective study including patients with colorectal liver metastases undergoing CT- or ultrasound-guided microwave or radiofrequency ablation during 2009-2022, reporting 3-year local disease progression (residual unablated tumour or local tumour progression) rates by minimum ablative margin across all institutions and identifying an intraprocedural contrast-enhanced CT-based minimum ablative margin associated with a 3-year local disease progression rate of less than 1%.
A total of 400 ablated colorectal liver metastases (median diameter of 1.5 cm) in 243 patients (145 men; median age of 62 [interquartile range 54-70] years) were evaluated, with a median follow-up of 26 (interquartile range 17-40) months. A total of 119 (48.9%) patients with 186 (46.5%) colorectal liver metastases were from international institutions B, C, and D that were not involved in the software development. Three-year local disease progression rates for 0 mm, >0 and <5 mm, and 5 mm or larger minimum ablative margins were 79%, 15%, and 0% respectively for institution A (where the software was developed) and 34%, 19%, and 2% respectively for institutions B, C, and D combined. Local disease progression risk decreased to less than 1% with an intraprocedurally confirmed minimum ablative margin greater than 4.6 mm.
A minimum ablative margin of 5 mm or larger demonstrates optimal local oncological outcomes. It is proposed that an intraprocedural minimum ablative margin of 5 mm or larger, confirmed using biomechanical deformable image registration, serves as the A0 for colorectal liver metastasis thermal ablation.
为了改善接受结直肠肝转移热消融治疗的患者的局部疗效，最近已经开发了几种消融确认软件方法来评估最小消融边界。以前的评估仅限于单个机构，主要是在开发的地方。本研究的目的是在多机构环境中使用自动分割和生物力学变形图像配准验证以前确定的 5 毫米最小消融边界（A0）。
这是一项多中心、回顾性研究，纳入了 2009 年至 2022 年期间接受 CT 或超声引导下微波或射频消融治疗的结直肠肝转移患者，报告了所有机构的 3 年局部疾病进展（残留未消融肿瘤或局部肿瘤进展）率，并确定了术中基于增强 CT 的最小消融边界，该边界与 3 年局部疾病进展率低于 1%相关。
共评估了 243 例患者（145 例男性；中位年龄 62 岁[四分位距 54-70 岁]）的 400 个消融结直肠肝转移灶（中位直径 1.5 厘米），中位随访时间为 26 个月（四分位距 17-40 个月）。共有来自国际机构 B、C 和 D 的 119 例（48.9%）患者和 186 例（46.5%）结直肠肝转移灶未参与软件开发。在软件开发机构 A 中，0 毫米、>0 毫米和<5 毫米以及 5 毫米或更大的最小消融边界的 3 年局部疾病进展率分别为 79%、15%和 0%，而机构 B、C 和 D 的 3 年局部疾病进展率分别为 34%、19%和 2%。术中确认的最小消融边界大于 4.6 毫米时，局部疾病进展风险降至 1%以下。
5 毫米或更大的最小消融边界显示出最佳的局部肿瘤学结果。建议使用生物力学变形图像配准确认术中 5 毫米或更大的最小消融边界作为结直肠肝转移热消融的 A0。
