Intraprocedural Versus Initial Follow-up Minimal Ablative Margin Assessment After Colorectal Liver Metastasis Thermal Ablation: Which One Better Predicts Local Outcomes?
Intraprocedural Versus Initial Follow-up Minimal Ablative Margin Assessment After Colorectal Liver Metastasis Thermal Ablation: Which One Better Predicts Local Outcomes?
复制标题
结直肠肝转移热消融后术中与初始随访最小消融边缘评估：哪一种更好地预测局部结果？
DOI：
10.1097/rli.0000000000001023
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发表时间：
2024
影响因子：
6.7
通讯作者：
Odisio,BrunoC
中科院分区：
文献类型：
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作者：
Lin,Yuan-Mao;Paolucci,Iwan;AlbuquerqueMarquesSilva,Jessica;O'Connor,CalebS;Fellman,BryanM;Jones,AaronK;Kuban,JoshuaD;Huang,StevenY;Metwalli,ZeyadA;Brock,KristyK;Odisio,BrunoC
目的本研究的目的是探讨通过术中与初始随访计算机断层扫描 (CT) 量化的 3 维最小消融切缘 (MAM) 在预测结直肠肝转移 (CLM) 热消融后局部肿瘤进展 (LTP) 中的预后价值。 2016 年和 2021 年。排除术中和初始随访对比增强 CT、残留肿瘤或随访时间少于 1 年但未进行 LTP 的患者。通过生物力学可变形图像配准方法量化最小消融边缘，该方法对术中预消融 CT 上的 CLM 进行分割，以及术中后消融和初始随访 CT 上的消融区域。使用曲线下面积和竞争风险回归模型测试 MAM 预测 LTP 的预后价值。结果 总共纳入 68 名患有 133 个 CLM 的患者（平均年龄±标准差，57±12 岁；43 名男性）。中位随访时间为 30.3 个月，LTP 率为 17%（22/133）。术中和初次随访 CT 分割的消融区域中位体积分别为 27 mL 和 16 mL（P<0.001），相应的中位 MAM 分别为 4.7 mm 和 0 mm（P<0.001）。在预测 1 年 LTP 方面，术中 CT 量化的 MAM 曲线下面积（0.89；95% 置信区间 [CI]，0.83–0.94）高于初始随访 CT（0.66；95% CI，0.54–0.76）（P< 0.001）。术中 CT 上的 MAM 为 0 mm 是 LTP 的独立预测因子，其次分布风险比为 11.9（95% CI，4.9–28.9；P< 0.001），而初次随访 CT 上的次分布风险比为 2.4（95% CI，0.9–6.0；P= 0.07）。 结论 术中 CT 上的消融边缘量化显着在预测 LTP 方面优于初始随访 CT，应用于消融终点评估。
ObjectivesThe aim of this study was to investigate the prognostic value of 3-dimensional minimal ablative margin (MAM) quantified by intraprocedural versus initial follow-up computed tomography (CT) in predicting local tumor progression (LTP) after colorectal liver metastasis (CLM) thermal ablation.Materials and MethodsThis single-institution, patient-clustered, tumor-based retrospective study included patients undergoing microwave and radiofrequency ablation between 2016 and 2021. Patients without intraprocedural and initial follow-up contrast-enhanced CT, residual tumors, or with follow-up less than 1 year without LTP were excluded. Minimal ablative margin was quantified by a biomechanical deformable image registration method with segmentations of CLMs on intraprocedural preablation CT and ablation zones on intraprocedural postablation and initial follow-up CT. Prognostic value of MAM to predict LTP was tested using area under the curve and competing-risk regression model.ResultsA total of 68 patients (mean age±standard deviation, 57±12 years; 43 men) with 133 CLMs were included. During a median follow-up of 30.3 months, LTP rate was 17%(22/133). The median volume of ablation zone was 27 mL and 16 mL segmented on intraprocedural and initial follow-up CT, respectively (P< 0.001), with corresponding median MAM of 4.7 mm and 0 mm, respectively (P< 0.001). The area under the curve was higher for MAM quantified on intraprocedural CT (0.89; 95% confidence interval [CI], 0.83–0.94) compared with initial follow-up CT (0.66; 95% CI, 0.54–0.76) in predicting 1-year LTP (P< 0.001). An MAM of 0 mm on intraprocedural CT was an independent predictor of LTP with a subdistribution hazards ratio of 11.9 (95% CI, 4.9–28.9; P< 0.001), compared with 2.4 (95% CI, 0.9–6.0; P= 0.07) on initial follow-up CT.ConclusionsAblative margin quantified on intraprocedural CT significantly outperformed initial follow-up CT in predicting LTP and should be used for ablation endpoint assessment.