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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).
Index terms
Local Neoplasm Recurrence, Neoplasm Metastasis, Radiofrequency Thermal Ablation, Colorectal Neoplasm, LaparoscopyREFERENCES
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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
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
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
Table 1.
A Comparison of the Baseline Characteristics Per Nodule
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∗ |
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∗ |
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