Journal List > J Korean Soc Radiol > v.76(3) > 1087771

Jeon, Cho, Choi, Kim, and Lee: Analysis of Factors Affecting Local Tumor Progression of Colorectal Cancer Liver Metastasis after Radiofrequency Ablation

Abstract

Purpose

The purpose of this study was to evaluate the independent predictive factors for local tumor progression (LTP) of colorectal liver metastasis (CRLM) after radiofrequency ablation (RFA).

Materials and Methods

Patients with CRLM were included in the analysis if nod-ules were up to five in number, each nodule was ≤ 5 cm, and RFA was performed in our center from January 2006 to December 2015. Univariate and multivariate anal-yses to identify the predictors of LTP were performed by using a Cox proportional hazard model.

Results

Overall, 58 tumors from 38 patients were included in this study. LTP oc-curred in 14 tumors from 9 patients. The overall 1- and 3-year LTP rates were 23.5% and 29.4%, respectively. Multivariate analysis showed that tumor size > 2 cm and insufficient ablative margin were two independently significant adverse prognostic factors for LTP (p = 0.045 and 0.022, respectively). The 3-year LTP rates for 33 and 25 tumors with and without sufficient ablative margin were 4.5% and 61.2%, respectively. The difference was statistically significant (p < 0.001). The difference in the 3-year LTP rates according to the tumor size was not statistically significant (p = 0.791).

Conclusion

Insufficient ablative margin seems to be the most potent predictor of LTP after RFA of CRLM.

Index terms

Local Neoplasm Recurrence, Neoplasm Metastasis, Radiofrequency Thermal Ablation, Colorectal Neoplasm, Laparoscopy

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Fig. 1.
A 68-year-old male patient with rectosigmoid colon cancer. A. A 3.6 cm sized hypodense nodule with peripheral rim enhancement (black arrow) is newly detected in the right lobe of the liver on initial abdomen CT, suggesting liver metastasis. B, C. Eight days after intraoperative RFA using multiple separable electrodes, followup axial (B) and coronal (C) CT show a 5.8 cm hypodense ablation zone with a sufficient ablative margin surrounding the ablation index tumor. D. Nine months after intraoperative RFA, the ablation zone is markedly decreased in size without evidence of local recurrence. RFA = radiofrequency ablation
jksr-76-179f1.tif
Fig. 2.
A 77-year-old male patient with rectal cancer. A. A 1.9 cm sized, hypodense nodule with peripheral rim enhancement (black arrow) is newly detected in the left lobe of the liver on followup abdomen CT, suggesting liver metastasis. B. Percutaneous RFA was conducted using an internally cooled single electrode. White arrow indicates the ablation index tumor. C. A CT image taken five months after RFA shows that the previous ablation zone is markedly increased in extent, and multiple liver metastases are newly developed in the other sites. RFA = radiofrequency ablation
jksr-76-179f2.tif
Fig. 3.
A comparison of the LTP rates for colorectal liver metastasis between the patients, confined to the subgroup, undergoing percutaneous and intraoperative RFA. The 3-year LTP rates after RFA using the intraoperative or percutaneous approach are significantly different; 14.4% vs. 37.9%, with statistical significance (p = 0.033). LTP = local tumor progression, RFA = radiofrequency ablation
jksr-76-179f3.tif
Table 1.
A Comparison of the Baseline Characteristics Per Nodule
  n %
Age (years) (< 75/≥ 75) 36/22 62.1/37.9
Gender (male/female) 53/5 91.4/8.6
Dominant liver tumor size (≤ 2 cm/> 2 cm) 47/11 81/19
No. of liver tumor (single/multiple) 28/30 48.3/51.7
Adjacent to large intrahepatic vessels > 3 mm (yes/no) 12/46 20.7/79.3
Presence of a liver dome nodule (yes/no) 11/47 19/81
Presence of a subcapsular tumor (yes/no) 34/24 58.6/41.4
Adjuvant chemotherapy (yes/no) 28/30 48.3/51.7
Synchronous lung metastasis (yes/no) 10/48 17.2/82.8
Synchronous lymph node invasion (yes no) 2/56 3.4/96.6
Serum level of CEA (≤10/>10 ng/mL) 32/26 55.2/44.8
Other malignancies (yes/no) 2/56 3.5/96.5
RF electrode type    
 Internally cooled single 18 31
 Internally cooled clustered 20 34.5
 Multiple seperable 12 20.7
 Expandable 6 10.3
 Internally cooled wet 2 3.4
Ablative margin (≥ 0.5 cm/< 0.5 cm) 26/32 44.8/55.2
Primary TNM staging of colorectal cancer    
 I 1 1.7
 IIA 6 10.3
 IIIA 2 3.4
 IIIB 20 34.5
 IVA 29 50

CEA = carcinoembryonic antigen, RF = radiofrequency

Table 2.
Univariate Analysis of Prognostic Factors for the Local Tumor Progression of Colorectal Liver Metastasis after RF Ablation Per Nodule
  Hazard Ratio Standard Error p-Value
Age ≥ 70 years old 0.584 (0.161–2.111) 0.656 0.412
Male gender 24.111 (0.013–43445.559) 3.825 0.405
Tumor size > 2 cm 1.169 (0.364–3.756) 0.596 0.793
Multiple tumors 1.785 (0.613–5.202) 0.546 0.288
Adjacent to large intrahepatic vessels > 3 mm in the diameter 0.399 (0.052–3.077) 1.042 0.378
Presence of a dome nodule 0.572 (0.128–2.559) 0.764 0.465
Presence of a subcapsular tumor 0.607 (0.212–1.740) 0.537 0.353
Adjuvant chemotherapy 0.942 (0.321–2.769) 0.550 0.914
Synchronous lung metastasis 1.474 (0.461–4.710) 0.593 0.513
Synchronous lymph node invasion 0.048 (0.000–149409.647) 7.632 0.690
Serum level of CEA >10 ng/mL 2.693 (0.901–8.052) 0.559 0.076
Presence of other malignancies 2.319 (0.301–17.880) 1.042 0.420
Intraoperative approach 0.228 (0.051–1.023) 0.765 0.054
RF electrode type     0.235
 Internally cooled single 1 (reference group)
 Internally cooled clustered 0.261 (0.055-1.240) 0.795 0.091
 Others 0.678 (0.202-2.274) 0.618 0.529
Ablative margin ≥ 0.5 cm 0.102 (0.023-0.458) 0.767 0.003

Statistically significant.

CEA = carcinoembryonic antigen, RF = radiofrequency

Table 3.
Multivariate Analysis of Prognostic Factors for the Local Tumor Progression of Colorectal Liver Metastasis after RF Ablation Per Nodule
  Hazard Ratio Standard Error p-Value
Tumor size > 2 cm 10.363 (1.405–76.44) 1.020 0.022
Serum level of CEA >10 ng/mL 2.260 (0.681–7.502) 0.612 0.183
Intraoperative approach 0.435 (0.049–3.864) 1.114 0.455
RF electrode type     0.304
Internally cooled single 1 (reference group)
Internally cooled clustered 0.129 (0.012–1.404) 1.217 0.093
Others 0.592 (0.160–2.191) 0.667 0.433
Ablative margin ≥ 0.5 cm 0.105 (0.011–0.955) 1.128 0.045

Statistically significant.

CEA = carcinoembryonic antigen, RF = radiofrequency

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