Colorectal Cancer Liver Metastases: Biopsy of the Ablation Zone and Margins Can Be Used to Predict Oncologic Outcome
Colorectal Cancer Liver Metastases: Biopsy of the Ablation Zone and Margins Can Be Used to Predict Oncologic Outcome
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DOI：
10.1148/radiol.2016151005
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发表时间：
2016-09-01
期刊：
影响因子：
19.7
通讯作者：
Sofocleous, Constantinos T.
中科院分区：
文献类型：
--
作者：
Sotirchos, Vlasios S.;Petrovic, Lydia M.;Sofocleous, Constantinos T.
目的：建立结直肠癌肝转移灶（CLM）射频（RF）消融后中央和边缘消融区活检对局部肿瘤进展（LTP）时间的预后价值：共47例患者（67个CLM）在2009年11月至2012年8月期间参加了这项前瞻性机构审查委员会批准和符合HIPAA的研究。平均肿瘤大小为2.1 cm（范围：0.6-4.3 cm）。射频消融后立即对消融区中心和边缘进行活检（每个消融区的活检样本平均数量为1.9），并评价是否存在活肿瘤细胞。在形态学评价时，用免疫组织化学进一步询问含有肿瘤细胞的样本，并将其分类为阳性、存活肿瘤（V）或阴性、坏死（N）。在消融后4-8周进行的首次消融后CT研究中评价了最小消融边缘尺寸。变量进行了评估，预测的时间与竞争风险模型（单因素和多因素分析）LTP。结果：技术的有效性是显而易见的，在66 67（98%）消融病变的第一次造影剂增强CT图像在4-8周的后续行动。12个月随访时LTP的累积发生率为22%（95%置信区间[CI]：12，32）。67个消融区中有16个（24%）的样本被归类为存活肿瘤。在单变量分析中，肿瘤大小、最小切缘大小和活检结果在预测LTP方面具有显著性。当这些变量随后进入多变量模型时，边缘尺寸小于5 mm（P = 0.001;风险比[HR]，6.7）和阳性活检结果（P = 0.008; HR，3.4）具有显著性。射频消融后12个月内的LTP是在3%（95%CI：0，9）的坏死CLMs与利润至少5毫米。结论：活检证明肿瘤完全消融和最小消融利润至少5毫米是独立的预测因子LTP，并产生最好的肿瘤学结果。(C)RSNA，2016.
Purpose: To establish the prognostic value of biopsy of the central and marginal ablation zones for time to local tumor progression (LTP) after radiofrequency (RF) ablation of colorectal cancer liver metastasis (CLM).Materials and Methods: A total of 47 patients with 67 CLMs were enrolled in this prospective institutional review board-approved and HIPAA-compliant study between November 2009 and August 2012. Mean tumor size was 2.1 cm (range, 0.6-4.3 cm). Biopsy of the center and margin of the ablation zone was performed immediately after RF ablation (mean number of biopsy samples per ablation zone, 1.9) and was evaluated for the presence of viable tumor cells. Samples containing tumor cells at morphologic evaluation were further interrogated with immunohistochemistry and were classified as either positive, viable tumor (V) or negative, necrotic (N). Minimal ablation margin size was evaluated in the first postablation CT study performed 4-8 weeks after ablation. Variables were evaluated as predictors of time to LTP with the competing-risks model (uni-and multivariate analyses).Results: Technical effectiveness was evident in 66 of 67 (98%) ablated lesions on the first contrast material-enhanced CT images at 4-8-week follow-up. The cumulative incidence of LTP at 12-month follow-up was 22% (95% confidence interval [CI]: 12, 32). Samples from 16 (24%) of 67 ablation zones were classified as viable tumor. At univariate analysis, tumor size, minimal margin size, and biopsy results were significant in predicting LTP. When these variables were subsequently entered in a multivariate model, margin size of less than 5 mm (P,.001; hazard ratio [HR], 6.7) and positive biopsy results (P =.008; HR, 3.4) were significant. LTP within 12 months after RF ablation was noted in 3% (95% CI: 0, 9) of necrotic CLMs with margins of at least 5 mm.Conclusion: Biopsy proof of complete tumor ablation and minimal ablation margins of at least 5 mm are independent predictors of LTP and yield the best oncologic outcomes. (C) RSNA, 2016.