Ablation of colorectal liver metastasis: Interaction of ablation margins and RAS mutation profiling on local tumour progression-free survival
Ablation of colorectal liver metastasis: Interaction of ablation margins and RAS mutation profiling on local tumour progression-free survival
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DOI：
10.1007/s00330-017-5273-2
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发表时间：
2018-07-01
影响因子：
5.9
通讯作者：
Odisio, Bruno C.
中科院分区：
文献类型：
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作者：
Calandri, Marco;Yamashita, Suguru;Odisio, Bruno C.
根据结直肠肝转移（CLM）患者的RAS状态，研究消融切缘对局部肿瘤无进展生存期（LTPFS）的影响。这项2005-2016年的两家机构回顾性研究纳入了136例（91例男性，中位年龄60岁）218例消融CLM患者。使用Kaplan-Meier方法进行LTPFS，并使用对数秩检验进行评价。使用Cox回归模型进行单因素/多因素分析，在muco-RAS（29% vs. 48%，p=0.038）和野生型RAS（70% vs. 94%，p=0.039）亚组中，最小消融边缘ae <10 mm的CLM的3年LTPFS率显著低于> 10 mm的CLM。在最小消融边缘ae <10 mm（29% vs. 70%，p < 0.001）和> 10 mm（48% vs. 94%，p=0.006）的两个CLM亚组中，mu-RAS的3年LTPFS率显著差于野生型RAS。更差的LTPFS的预测因子为消融边缘ae 10 mm（HR：2.17，95%CI 1.2-4.1，p=0.007）、CLM尺寸ae 2 cm（1.80，1.1-2.8，p=0.017）和多RAS（2.85，1.7-4.6，p < 0.001）。最小消融边缘和RAS状态相互作用，是CLM消融后LTPFS的独立预测因子。尽管最小消融边缘> 10 mm应始终是手术目标，但这对于突变型RAS CLM尤为重要。RAS和消融边缘是局部肿瘤无进展生存的预测因素。消融边缘> 10 mm始终可取，对于突变型RAS转移至关重要。介入放射科医生应了解RAS状态以优化LTPFS。
To investigate effects of ablation margins on local tumour progression-free survival (LTPFS) according to RAS status in patients with colorectal liver metastases (CLM).This two-institution retrospective study from 2005-2016 included 136 patients (91 male, median age 60 years) with 218 ablated CLM. LTPFS was performed using the Kaplan-Meier method and evaluated with the log-rank test. Uni/multivariate analyses were performed using Cox-regression models.Three-year LTPFS rates for CLM with minimal ablation margin ae10 mm were significantly worse than those with > 10 mm in both mutant-RAS (29% vs. 48%, p=0.038) and wild-type RAS (70% vs. 94%, p=0.039) subgroups. Three-year LTPFS rates of mutant-RAS were significantly worse than wild-type RAS in both CLM subgroups with minimal ablation margin ae10 mm (29% vs. 70%, p < 0.001) and > 10 mm (48% vs. 94%, p=0.006). Predictors of worse LTPFS were ablation margins ae10 mm (HR: 2.17, 95% CI 1.2-4.1, p=0.007), CLM size ae2 cm (1.80, 1.1-2.8, p=0.017) and mutant-RAS (2.85, 1.7-4.6, p < 0.001).Minimal ablation margin and RAS status interact as independent predictors of LTPFS following CLM ablation. While minimal ablation margins > 10 mm should be always the procedural goal, this becomes especially critical for mutant-RAS CLM.RAS and ablation margins are predictors of local tumour progression-free survival.Ablation margin > 10 mm, always desirable, is crucial for mutant RAS metastases.Interventional radiologists should be aware of RAS status to optimize LTPFS.