Predictors of survival after radiofrequency thermal ablation of colorectal cancer metastases to the liver: A prospective study
Predictors of survival after radiofrequency thermal ablation of colorectal cancer metastases to the liver: A prospective study
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DOI：
10.1200/jco.2005.12.039
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发表时间：
2005-03-01
影响因子：
45.3
通讯作者：
Siperstein, AE
中科院分区：
文献类型：
--
作者：
Berber, E;Pelley, R;Siperstein, AE
目的 本研究的目的是确定结直肠肝转移患者射频热消融 (RFA) 时生存的预测因素。患者和方法 135 名不适合切除的结直肠肝转移患者接受了腹腔镜 RFA。结果所有患者在 RFA 治疗后的中位 Kaplan-Meier 生存期为 28.9 个月。与 CEA 大于 200 的患者相比，癌胚抗原 (CEA) 小于 200 ng/mL 的患者生存率有所提高（34 个月 vs 16 个月；P = .01）。主要病灶直径小于 3 cm 的患者的中位生存期为 38 个月，病灶直径为 3 至 5 cm 的患者为 34 个月，病灶大于 5 cm 的患者中位生存期为 21 个月 (P = .03)。患有一到三个肿瘤的患者与超过三个肿瘤的患者相比，生存期接近显着性（29 个月与 22 个月；P = .09）。肝外疾病的存在并不影响生存。通过 Cox 比例风险模型，仅发现大于 5 厘米的最大肝脏肿瘤是死亡率的显着预测因子，与小于 3 厘米的最大肝脏肿瘤相比，死亡风险增加 2.5 倍 (P = .05)。 结论 本研究确定哪些患者在 RFA 后效果最好。单纯化疗的历史生存期为 11 至 14 个月，表明 RFA 对总生存期有积极影响。有限数量的肝外疾病似乎不会对生存产生不利影响。对于肝病患者来说，射频消融是化疗的有效辅助手段。
Purpose The aim of this study was to determine the predictors of survival at the time of radio-frequency thermal ablation (RFA) in patients with colorectal liver metastasis.Patients and Methods One hundred thirty-five patients with colorectal liver metastases who were not candidates for resection underwent laparoscopic RFA.Results The median Kaplan-Meier survival for all patients was 28.9 months after RFA treatment. Patients with a carcinoembryonic antigen (CEA) less than 200 ng/mL had improved survival compared with those with a CEA more than 200 (34 v 16 months; P = .01). Patients with the dominant lesion less than 3 cm in diameter had a median survival of 38 v 34 months for lesions 3 to 5 cm, and 21 months for lesions greater than 5 cm (P = .03). Survival approached significance for patients with one to three tumors versus more than three tumors (29 v 22 months; P = .09). The presence of extrahepatic disease did not affect survival. Only the largest liver tumor size more than 5 cm was found to be a significant predictor of mortality by Cox proportional hazards model, with a 2.5-fold increased risk of death versus the largest liver tumor size less than 3 cm (P = .05).Conclusion This study determines which patients do best after RFA. Historical survival with chemotherapy alone is 11 to 14 months, suggesting RFA has a positive impact on overall survival. Limited amounts of extrahepatic disease do not appear to affect survival adversely. RFA is a useful adjunct to chemotherapy in those patients with liver-predominant disease.