Thermal Ablation Compared to Partial Hepatectomy for Recurrent Colorectal Liver Metastases: An Amsterdam Colorectal Liver Met Registry (AmCORE) Based Study.
Thermal Ablation Compared to Partial Hepatectomy for Recurrent Colorectal Liver Metastases: An Amsterdam Colorectal Liver Met Registry (AmCORE) Based Study.
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DOI：
10.3390/cancers13112769
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发表时间：
2021-06-02
期刊：
影响因子：
5.2
通讯作者：
Meijerink MR
中科院分区：
文献类型：
--
作者：
Dijkstra M;Nieuwenhuizen S;Puijk RS;Timmer FEF;Geboers B;Schouten EAC;Opperman J;Scheffer HJ;Vries JJJ;Swijnenburg RJ;Versteeg KS;Lissenberg-Witte BI;van den Tol MP;Meijerink MR
64%至85%的结直肠肝转移（CRLM）患者在根治性局部治疗后发生远处肝内复发。新CRLM的当前标准治疗是重复局部治疗，包括部分肝切除术和热消融。虽然相对安全可行，但由于粘连和术后肝脏体积减少，重复部分肝切除术可能具有挑战性。这项基于AmCORE的研究评估了复发性CRLM患者中重复热消融与重复部分肝切除术相比的安全性、有效性和生存结局。重复部分肝切除术与重复热消融术在生存率、远端和局部复发率和并发症方面没有差异，而住院时间有利于重复热消融术。热消融应被视为治疗复发性新发CRLM的有效且潜在侵入性较小的替代方法，而COLLISION试验（NCT 03088150）的热切期待的结果应提供关于CRLM手术与热消融的明确答案。本研究的目的是评估复发性结直肠肝转移（CRLM）患者中重复热消融与重复部分肝切除术相比的安全性、有效性和生存结局。这项基于阿姆斯特丹结直肠肝转移登记（AmCORE）的两个队列研究，重复热消融与重复部分肝切除术，分析了2002年5月至2020年12月期间复发性CRLM的136例患者（100例热消融，36例部分肝切除）和224例肿瘤（170例热消融，54例部分肝切除）。主要和次要终点为总生存期（OS）、远端无进展生存期（DPFS）和局部肿瘤无进展生存期（LTPFS）（使用Kaplan-Meier方法估计）和并发症（使用卡方检验分析）。基于考克斯比例风险模型的多变量分析用于解释潜在混杂因素。此外，根据患者、初始和重复局部治疗特征进行亚组分析。在粗略的总体比较中，接受重复部分肝切除术治疗的患者的OS与重复热消融治疗的患者的OS无统计学差异（p = 0.927）。在考虑潜在混杂因素后，OS的进一步定量证实了重复局部治疗的一致结果（风险比（HR），0.986; 95%置信区间（CI），0.517-1.881; p = 0.966）。热消融组1、3、5年总生存率分别为98.9%、62.6%、42.3%，再次切除组分别为93.8%、74.5%、49.3%。DPFS（p = 0.942）、LTPFS（p = 0.397）和并发症发生率（p = 0.063）无差异。重复热消融组的平均住院时间为2.1天，重复部分肝切除组为4.8天（p = 0.009）。根据患者、初始和重复局部治疗特征，亚组分析未发现异质性治疗效应。在OS、DPFS、LTPFS和并发症方面，重复部分肝切除术与重复热消融术无统计学差异，而住院时间有利于重复热消融术。在复发性新发CRLM的治疗中，热消融应被视为小尺寸（0-3 cm）CRLM的有效且潜在侵入性较小的替代方法。然而，期待已久的III期前瞻性随机对照COLLISION试验（NCT 03088150）的结果应该为CRLM的手术与热消融提供明确的答案。
Between 64 and 85% of patients with colorectal liver metastases (CRLM) develop distant intrahepatic recurrence after curative intent local treatment. The current standard of care for new CRLM is repeat local treatment, comprising partial hepatectomy and thermal ablation. Although relatively safe and feasible, repeat partial hepatectomy can be challenging due to adhesions and due to the reduced liver volume after surgery. This AmCORE based study assessed safety, efficacy and survival outcomes of repeat thermal ablation as compared to repeat partial hepatectomy in patients with recurrent CRLM. Repeat partial hepatectomy was not different from repeat thermal ablation with regard to survival, distant- and local recurrence rates and complications, whereas length of hospital stay favored repeat thermal ablation. Thermal ablation should be considered a valid and potentially less invasive alternative in the treatment of recurrent new CRLM, while the eagerly awaited results of the COLLISION trial (NCT03088150) should provide definitive answers regarding surgery versus thermal ablation for CRLM. The aim of this study was to assess safety, efficacy and survival outcomes of repeat thermal ablation as compared to repeat partial hepatectomy in patients with recurrent colorectal liver metastases (CRLM). This Amsterdam Colorectal Liver Met Registry (AmCORE) based study of two cohorts, repeat thermal ablation versus repeat partial hepatectomy, analyzed 136 patients (100 thermal ablation, 36 partial hepatectomy) and 224 tumors (170 thermal ablation, 54 partial hepatectomy) with recurrent CRLM from May 2002 to December 2020. The primary and secondary endpoints were overall survival (OS), distant progression-free survival (DPFS) and local tumor progression-free survival (LTPFS), estimated using the Kaplan–Meier method, and complications, analyzed using the chi-square test. Multivariable analyses based on Cox proportional hazards model were used to account for potential confounders. In addition, subgroup analyses according to patient, initial and repeat local treatment characteristics were performed. In the crude overall comparison, OS of patients treated with repeat partial hepatectomy was not statistically different from repeat thermal ablation (p = 0.927). Further quantification of OS, after accounting for potential confounders, demonstrated concordant results for repeat local treatment (hazard ratio (HR), 0.986; 95% confidence interval (CI), 0.517–1.881; p = 0.966). The 1-, 3- and 5-year OS were 98.9%, 62.6% and 42.3% respectively for the thermal ablation group and 93.8%, 74.5% and 49.3% for the repeat resection group. No differences in DPFS (p = 0.942), LTPFS (p = 0.397) and complication rate (p = 0.063) were found. Mean length of hospital stay was 2.1 days in the repeat thermal ablation group and 4.8 days in the repeat partial hepatectomy group (p = 0.009). Subgroup analyses identified no heterogeneous treatment effects according to patient, initial and repeat local treatment characteristics. Repeat partial hepatectomy was not statistically different from repeat thermal ablation with regard to OS, DPFS, LTPFS and complications, whereas length of hospital stay favored repeat thermal ablation. Thermal ablation should be considered a valid and potentially less invasive alternative for small-size (0–3 cm) CRLM in the treatment of recurrent new CRLM. While, the eagerly awaited results of the phase III prospective randomized controlled COLLISION trial (NCT03088150) should provide definitive answers regarding surgery versus thermal ablation for CRLM.
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作者：
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通讯作者：
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影响因子：
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影响因子：
5.2
作者：
Dijkstra M;Nieuwenhuizen S;Puijk RS;Geboers B;Timmer FEF;Schouten EAC;Scheffer HJ;de Vries JJJ;Ket JCF;Versteeg KS;Meijerink MR;van den Tol MP
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