Colorectal Liver Metastases Recurrence and Survival Following Hepatic Resection, Radiofrequency Ablation, and Combined Resection-Radiofrequency Ablation
Colorectal Liver Metastases Recurrence and Survival Following Hepatic Resection, Radiofrequency Ablation, and Combined Resection-Radiofrequency Ablation
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DOI：
10.1001/archsurg.143.12.1204
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发表时间：
2008-12-01
影响因子：
--
通讯作者：
Pawlik, Timothy M.
中科院分区：
文献类型：
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作者：
Gleisner, Ana L.;Choti, Michael A.;Pawlik, Timothy M.
假设：虽然射频消融 (RFA) 越来越被结直肠肝转移患者接受，但切除治疗与 RFA 治疗的患者可能具有不同的肿瘤生物学特征，这可能会混淆肝脏定向治疗的选择和结果之间的关系。设计：对前瞻性收集的数据库进行回顾性审查。地点：主要肝胆中心。患者：1999 年 1 月 1 日至 2006 年 8 月 30 日期间，258结直肠肝转移患者接受肝切除联合或不联合RFA。主要结果指标：使用3种统计方法（配对匹配对照、Cox比例风险多变量模型和倾向指数）评估单纯切除、联合切除-RFA和单独RFA后的结果，以识别和调整潜在的混杂变量。结果：肝病灶中位数为2，最大病灶中位数为3.0厘米。 192 名患者（74.4%）接受了单纯切除术，55 名患者（21.3%）接受了切除-RFA，11 名患者（4.3%）接受了单独 RFA。与仅接受切除术或仅接受 RFA 的患者相比，接受 RFA 切除的患者 1 年时发生肝外衰竭的风险显着增加 ( P < .05)。在匹配对照和多变量分析中，接受 RFA 联合或不联合切除的患者的无病生存率和总生存率明显低于仅接受切除术的患者。倾向评分方法显示，切除-RFA 的临床危险因素的总体分布与单纯切除明显不同。这表明在评估 RFA 治疗疗效的因果推论时缺乏可比性，无法进行统计比较。 结论：虽然匹配对照和多变量分析的结果表明，有或没有切除的 RFA 与较差的预后相关，但倾向评分方法显示，切除 RFA 组和单独切除组在基线肿瘤和治疗相关因素方面存在差异，使得有关 RFA 疗效的因果推论不可靠。
Hypothesis: Although radiofrequency ablation ( RFA) is increasingly an accepted option for patients with colorectal liver metastases, patients treated with resection vs RFA may have different tumor biology profiles, which might confound the relationship between choice of liver-directed therapy and outcome.Design: Retrospective review of a prospectively collected database.Setting: Major hepatobiliary center.Patients: Between January 1, 1999, and August 30, 2006, 258 patients with colorectal liver metastases underwent hepatic resection with or without RFA.Main Outcome Measures: Evaluation of outcome following resection alone, combined resection-RFA, and RFA alone using 3 statistical methods ( paired-match control, Cox proportional hazards multivariate model, and propensity index) to identify and adjust for potential confounding variables.Results: The median number of hepatic lesions was 2, and the median size of the largest lesion was 3.0 cm. One hundred ninety-two patients ( 74.4%) underwent resection alone, 55 patients ( 21.3%) underwent resection-RFA, and 11 patients ( 4.3%) underwent RFA alone. Patients who underwent resection-RFA had significantly increased risk of extrahepatic failure at 1 year vs patients who underwent resection alone or RFA alone ( P < .05). On matched control and multivariate analyses, patients who underwent RFA with or without resection had significantly worse disease-free and overall survival than patients who underwent resection alone. Propensity score methods revealed that the aggregate distribution of clinical risk factors for resection-RFA was markedly different from that for resection alone. This suggested a lack of comparability to allow for statistical comparisons in the assessment of causal inferences regarding the efficacy of RFA therapy.Conclusion: Although results of matched control and multivariate analyses suggested that RFA with or without resection was associated with worse outcome, propensity score methods revealed that the resection-RFA and resection-alone groups were different with regard to baseline tumor and treatment-related factors, making causal inferences about the efficacy of RFA unreliable.