Wehrle Chase J, Sarioglu Ali Gunduz, Akgun Ege, Berber Eren
Cleveland Clinic Foundation, Digestive Diseases and Surgery Institute, Cleveland, OH. Electronic address: https://twitter.com/ChaseWehrle.
Cleveland Clinic Foundation, Digestive Diseases and Surgery Institute, Cleveland, OH.
Surgery. 2025 Mar;179:108807. doi: 10.1016/j.surg.2024.07.070. Epub 2024 Sep 25.
Kirsten rat sarcoma mutation was reported to adversely affect local tumor control after percutaneous ablation of colorectal liver metastasis. Nevertheless, the effect of Kirsten rat sarcoma mutation on surgical ablation has not been investigated in the literature. The aim of this study is to analyze the impact of Kirsten rat sarcoma mutation on local recurrence after surgical ablation of colorectal liver metastasis.
This was an institutional review board-approved study of patients who underwent surgical ablation of colorectal liver metastasis between 2005 and 2023 at a single center and underwent Kirsten rat sarcoma testing with ≥1 year follow-up. Local recurrence was analyzed using univariate Kaplan-Meier and multivariate Cox hazard models.
A total of 163 patients with 424 lesions fulfilled inclusion criteria. Fifty (30.7%) patients received radiofrequency ablation and 113 (69.3%) patients received microwave ablation. Fifty-seven patients (32.2%) with 177 lesions were found to have a Kirsten rat sarcoma mutation. Patients with Kirsten rat sarcoma mutation had a larger number of tumors, percentage of posteriorly located tumors, and tumor burden score compared with those with wild-type Kirsten rat sarcoma. Nevertheless, there was no difference between the groups regarding local recurrence per lesion (15% vs 17%, respectively, P = not significant). Independent predictors of local recurrence included tumor size, ablation margin, and blood vessel proximity for radiofrequency ablation compared with tumor size and ablation margin for microwave ablation.
There was no effect of Kirsten rat sarcoma mutations on local recurrence after surgical radiofrequency ablation or microwave ablation of colorectal liver metastasis in this study. Tumor size and ablation margin remained as independent predictors.
据报道， Kirsten大鼠肉瘤突变对结直肠癌肝转移经皮消融后的局部肿瘤控制有不利影响。然而，文献中尚未研究Kirsten大鼠肉瘤突变对手术消融的影响。本研究的目的是分析Kirsten大鼠肉瘤突变对结直肠癌肝转移手术消融后局部复发的影响。
这是一项经机构审查委员会批准的研究，研究对象为2005年至2023年在单一中心接受结直肠癌肝转移手术消融且接受Kirsten大鼠肉瘤检测并随访≥1年的患者。使用单变量Kaplan-Meier和多变量Cox风险模型分析局部复发情况。
共有163例患者的424个病灶符合纳入标准。50例（30.7%）患者接受了射频消融，113例（69.3%）患者接受了微波消融。57例（32.2%）患者的177个病灶被发现存在Kirsten大鼠肉瘤突变。与野生型Kirsten大鼠肉瘤患者相比，Kirsten大鼠肉瘤突变患者的肿瘤数量更多、位于后方的肿瘤百分比更高且肿瘤负荷评分更高。然而，两组之间每个病灶的局部复发情况没有差异（分别为15%和17%，P =无统计学意义）。局部复发的独立预测因素包括射频消融时的肿瘤大小、消融边缘和与血管的接近程度，而微波消融时为肿瘤大小和消融边缘。
在本研究中，Kirsten大鼠肉瘤突变对结直肠癌肝转移手术射频消融或微波消融后的局部复发没有影响。肿瘤大小和消融边缘仍然是独立的预测因素。
