Abstract：
BACKGROUND: Thermal ablation has recently become a key therapy for the treatment of colorectal liver metastasis (CLM). However, the role of ablation in combination with resection has not yet been firmly established. We hypothesize that in patients with CLM, those who undergo liver resection with ablation (RA) have similar outcomes compared with those who undergo liver resection only.
METHODS: We reviewed a multicenter international database of 906 surgical procedures for CLM from 5 high volume hepatobiliary surgical units. Patients undergoing RA (n = 63) were matched based on the number of lesions and tumor size using a 1:1 balanced propensity score analysis with those having resection only (n = 63). Our primary outcomes were overall survival (OS) and disease-free survival (DFS).
RESULTS: The mean age of our cohort was 58 ± 11 years, with 43% females. With a median follow-up of 70.8 months, patients in the resection and RA group had a median OS of 45.1 and 54.8 months (p = 0.71), respectively. The median DFS was 22.7 and 14.2 months (p = 0.045), respectively. Using a multivariate Cox proportional hazards regression model, the treatment approach was not associated with OS (p = 0.94) or DFS (p = 0.059). A higher number of lesions is independently associated with worse DFS (hazard ratio: 1.12, p < 0.01). When there was disease recurrence, the region of recurrence was similar between the RA versus resection only groups (p = 0.27), but there was a shorter time to recurrence in the RA group (p = 0.002).
CONCLUSIONS: For CLM, the treatment approach was not significantly associated with OS or DFS, while tumor biology likely played an important role. Prospective research on the quality and effectiveness of thermal ablation combined with hepatic resection is warranted.
METHODS: We reviewed a multicenter international database of 906 surgical procedures for CLM from 5 high volume hepatobiliary surgical units. Patients undergoing RA (n = 63) were matched based on the number of lesions and tumor size using a 1:1 balanced propensity score analysis with those having resection only (n = 63). Our primary outcomes were overall survival (OS) and disease-free survival (DFS).
RESULTS: The mean age of our cohort was 58 ± 11 years, with 43% females. With a median follow-up of 70.8 months, patients in the resection and RA group had a median OS of 45.1 and 54.8 months (p = 0.71), respectively. The median DFS was 22.7 and 14.2 months (p = 0.045), respectively. Using a multivariate Cox proportional hazards regression model, the treatment approach was not associated with OS (p = 0.94) or DFS (p = 0.059). A higher number of lesions is independently associated with worse DFS (hazard ratio: 1.12, p < 0.01). When there was disease recurrence, the region of recurrence was similar between the RA versus resection only groups (p = 0.27), but there was a shorter time to recurrence in the RA group (p = 0.002).
CONCLUSIONS: For CLM, the treatment approach was not significantly associated with OS or DFS, while tumor biology likely played an important role. Prospective research on the quality and effectiveness of thermal ablation combined with hepatic resection is warranted.
摘要：
背景：热消融最近已成为治疗结直肠肝转移（CLM）的关键疗法。然而,消融联合切除的作用尚未得到确认.我们假设在CLM患者中，与仅接受肝切除术的患者相比,接受肝切除术联合消融(RA)的患者的结局相似.
方法：我们回顾了一个多中心国际数据库，该数据库包含来自5个高容量肝胆外科单元的906例CLM手术程序。接受RA的患者（n=63）使用1：1平衡倾向评分分析与仅切除的患者（n=63）根据病变数量和肿瘤大小进行匹配。我们的主要结果是总生存期（OS）和无病生存期（DFS）。
结果：我们队列的平均年龄为58±11岁，43%的女性。中位随访时间为70.8个月，切除和RA组患者的中位OS为45.1和54.8个月(p=0.71),分别。中位DFS为22.7个月和14.2个月（p=0.045），分别。使用多元Cox比例风险回归模型，治疗方法与OS(p=0.94)或DFS(p=0.059)无关.较高数量的病变与较差的DFS独立相关(风险比:1.12,p<0.01)。当疾病复发时，RA与仅切除组之间的复发区域相似（p=0.27），但RA组的复发时间较短(p=0.002).
结论：对于CLM，治疗方法与OS或DFS没有显着相关，而肿瘤生物学可能发挥了重要作用。有必要对热消融联合肝切除的质量和有效性进行前瞻性研究。
方法：我们回顾了一个多中心国际数据库，该数据库包含来自5个高容量肝胆外科单元的906例CLM手术程序。接受RA的患者（n=63）使用1：1平衡倾向评分分析与仅切除的患者（n=63）根据病变数量和肿瘤大小进行匹配。我们的主要结果是总生存期（OS）和无病生存期（DFS）。
结果：我们队列的平均年龄为58±11岁，43%的女性。中位随访时间为70.8个月，切除和RA组患者的中位OS为45.1和54.8个月(p=0.71),分别。中位DFS为22.7个月和14.2个月（p=0.045），分别。使用多元Cox比例风险回归模型，治疗方法与OS(p=0.94)或DFS(p=0.059)无关.较高数量的病变与较差的DFS独立相关(风险比:1.12,p<0.01)。当疾病复发时，RA与仅切除组之间的复发区域相似（p=0.27），但RA组的复发时间较短(p=0.002).
结论：对于CLM，治疗方法与OS或DFS没有显着相关，而肿瘤生物学可能发挥了重要作用。有必要对热消融联合肝切除的质量和有效性进行前瞻性研究。
