Outcomes after resection and/or radiofrequency ablation for recurrence after treatment of colorectal liver metastases
Outcomes after resection and/or radiofrequency ablation for recurrence after treatment of colorectal liver metastases
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DOI：
10.1002/bjs.10162
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发表时间：
2016-07-01
影响因子：
9.6
通讯作者：
de Jong, K. P.
中科院分区：
文献类型：
--
作者：
Hof, J.;Wertenbroek, M. W. J. L. A. E.;de Jong, K. P.
背景：重复肝切除治疗结直肠癌肝转移(CRLM)在有限数量的患者中是可能的，射频消融(RFA)是不能切除的CRLM的替代方案。这项研究的目的是分析这些干预措施的生存率。方法：这是一个数据库分析，这些患者在2000年至2013年期间接受了同步和异时CRLM的首次和重复干预。结果：在接受切除或RFA治疗的431例CRLMS患者中，有305例复发，其中160例患者进行了重复干预(切除和/或RFA或消融性放疗)。总体而言，在707次首次或重复干预后，516例(73.0%)复发，其中276例经治疗后复发。在第一次干预时，死亡的独立危险因素是淋巴结阳性的原发肿瘤(危险比(HR)1.40；P=0.030)、多个CRLM(HR 1.53；P=0.007)、癌胚抗原水平>200 ng/ml(HR 1.89；P=0.020)和最大CRLM>5 cm(HR 1.54；P=0.014)。肝切除和经皮射频消融作为第一次介入治疗的5年总生存率分别为51.9%和53%，中位总生存率为65.0(95%C.I.分别为47.3~82.6个月和62.1(52.2~72.1)个月。结论：RFA治疗不能切除的CRLM具有良好的肿瘤预后。每增加一次介入，射频消融术的应用就会逐渐增多。
Background: Repeat liver resection for colorectal liver metastases (CRLMs) is possible in a limited number of patients, with radiofrequency ablation (RFA) as an alternative for unresectable CRLMs. The aim of this study was to analyse survival rates with these interventions.Methods: This was a database analysis of patients who underwent first and repeat interventions for synchronous and metachronous CRLMs between 2000 and 2013. Descriptive and survival statistics were calculated.Results: Among 431 patients who underwent resection or RFA for CRLMs, 305 patients developed recurrences for which 160 repeat interventions (resection and/or RFA or ablative radiotherapy) were performed. In total, after 707 first or repeat interventions, 516 recurrences (73.0 per cent) developed, of which 276 were retreated curatively. At the time of first intervention, independent risk factors for death were lymph node-positive primary tumour (hazard ratio (HR) 1.40; P = 0.030), more than oneCRLM(HR 1.53; P = 0.007), carcinoembryonic antigen level exceeding 200 ng/ml (HR 1.89; P = 0.020) and size of largest CRLM greater than 5 cm (HR 1.54; P = 0.014). The 5-year overall survival rates for liver resection and percutaneous RFA as first intervention were 51.9 and 53 per cent, with a median overall survival of 65.0 (95 per cent c.i. 47.3 to 82.6) and 62.1 (52.2 to 72.1) months, respectively.Conclusion: RFA had good oncological outcomes in patients with unresectable CRLMs. Radiofrequency ablation is progressively more applied with each additional intervention.