Asanuma Kunihiro, Nakatsuka Atsuhiro, Nakamura Tomoki, Fujimori Masashi, Yamanaka Takashi, Hagi Tomohito, Matsuyama Yumi, Iino Takahiro, Hasegawa Masahiro
Department of Orthopedic Surgery, Mie University School of Medicine, Tsu, Japan;
Department of Radiology, Mie University School of Medicine, Tsu, Japan.
Anticancer Res. 2024 Dec;44(12):5463-5476. doi: 10.21873/anticanres.17372.
BACKGROUND/AIM: Cryoablation is a new, minimally invasive option for local tumor therapy that is attracting attention due to its potential interactions with the immune system. The purpose of this study was to evaluate the efficacy of cryoablation for local control of bone and soft tissue lesions, to elucidate risk factors for recurrence, and to clarify histological changes.
Participants comprised 25 patients who underwent cryoablation for 53 discrete lesions of bone or soft tissue recurrence after resection or as metastases of cancer or sarcoma. Local progression-free survival was evaluated after completion of cryoablation. The histology of tumor tissues resected after cryoablation was assessed for seven cases.
Local progression-free survival rates were 88.1% at 1 year and 79.7% at 2 and 3 years. Risk of local progression was significantly higher for recurrent lesions after resection, and for lesions ≥4.0 cm in diameter than for metastatic lesions, or lesions <4.0 cm, respectively (p<0.05 each). In a subgroup analysis of bone lesions, lesions with an extraskeletal component tended to be associated with worse local recurrence-free survival than those without an extraskeletal component. On histological examination, tissue in the ablated area was completely necrotic. In the border area between ablated and non-ablated areas, CD68-positive cells including CD16-M1-like and CD204-positive M2-like cells were more frequently observed than T cells.
Cryoablation has shown good anti-tumor efficacy across various tumor types, including those affecting the bone. However, local control was inadequate for recurrent lesions and tumors larger than 4.0 cm in diameter. Further analysis of the relationship between macrophages and cryoablation is needed and may provide critical insights into achieving a more effective anti-tumor response.
背景/目的：冷冻消融是一种新型的局部肿瘤治疗微创方法，因其与免疫系统的潜在相互作用而备受关注。本研究的目的是评估冷冻消融对骨和软组织病变局部控制的疗效，阐明复发的危险因素，并明确组织学变化。
研究对象包括25例患者，他们因骨或软组织复发（切除术后复发、癌症或肉瘤转移）接受了53个离散病灶的冷冻消融治疗。冷冻消融完成后评估局部无进展生存期。对7例冷冻消融后切除的肿瘤组织进行组织学评估。
1年时局部无进展生存率为88.1%，2年和3年时为79.7%。切除术后复发的病灶以及直径≥4.0 cm的病灶局部进展风险分别显著高于转移病灶或直径<4.0 cm的病灶（均p<0.05）。在骨病灶的亚组分析中，具有骨外成分的病灶比无骨外成分的病灶局部无复发生存期更差。组织学检查显示，消融区域的组织完全坏死。在消融区与未消融区的边界区域，观察到CD68阳性细胞（包括CD16 - M1样细胞和CD204阳性M2样细胞）比T细胞更常见。
冷冻消融在包括影响骨骼的各种肿瘤类型中均显示出良好的抗肿瘤疗效。然而，对于复发病灶和直径大于4.0 cm的肿瘤，局部控制不足。需要进一步分析巨噬细胞与冷冻消融之间的关系，这可能为实现更有效的抗肿瘤反应提供关键见解。
