Copyright
©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
Extrapulmonary metastases impact survival outcomes of thermal ablation for colorectal lung oligometastases: A multicenter study
Xiao-Feng Hu, Xiang-Jun Dong, Xin-Yue Gu, Ji-Hong Hu, Xing-Hai Li, Fen-Hua Zhao, Xiang-Wen Xia, Hong-Jie Fan, Shu-Feng Xu
Xiao-Feng Hu, Department of Oncology, Guangyuan Central Hospital, Guangyuan 628000, Sichuan Province, China
Xiang-Jun Dong, Xiang-Wen Xia, Hong-Jie Fan, Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
Xin-Yue Gu, Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
Ji-Hong Hu, Department of Minimally Invasive Intervention, The First Affiliated Hospital of Kunming Medical University, Kunming 650000, Yunnan Province, China
Xing-Hai Li, Department of Minimally Invasive Intervention, Ganzhou People’s Hospital, Ganzhou 341000, Jiangxi Province, China
Fen-Hua Zhao, Department of Radiology, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang 322100, Zhejiang Province, China
Shu-Feng Xu, Department of Radiology, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People’s Hospital, Quzhou 324000, Zhejiang Province, China
Co-first authors: Xiao-Feng Hu and Xiang-Jun Dong.
Co-corresponding authors: Hong-Jie Fan and Shu-Feng Xu.
Author contributions: Xu SF and Fan HJ made substantial contributions to the study’s conception and design; Hu XF, Gu XY, Xia XW, Hu JH, Li XH, and Xu SF were responsible for material preparation, data collection, and analysis; The initial draft of the manuscript was prepared by Hu XF; Hu XF and Zhao FH were responsible for data curation, formal analysis, investigation, conceptualization, and manuscript review and editing; Hu XF, Dong XJ, Gu XY, Hu JH, Li XH, Zhao FH, Xia XW, Fan HJ, Xu SF reviewed and approved the final submitted version.
Supported by the National Natural Science Foundation of China, No. 82302332 and No. 82272100; and Guiding Science and Technology Research Project of Quzhou, No. ZD2022020.
Institutional review board statement: This study was approved by the Ethics Review Committee of our hospital (No. IEC-2024-1130). All procedures were conducted in accordance with the ethical standards of the responsible committee on human experimentation and the Declaration of Helsinki.
Informed consent statement: Due to the retrospective nature of the study, the requirement for informed consent was waived.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Data sharing statement: The datasets analyzed during the current study are available from the corresponding author upon reasonable request.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Shu-Feng Xu, MD, Doctor, Department of Radiology, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People’s Hospital, No. 100 Minjiang Avenue, Kecheng District, Quzhou 324000, Zhejiang Province, China.
13957572346@163.com
Received: May 15, 2025
Revised: June 17, 2025
Accepted: September 1, 2025
Published online: October 14, 2025
Processing time: 152 Days and 18.2 Hours
BACKGROUND
Colorectal cancer (CRC) frequently metastasizes to the lungs, and image-guided thermal ablation (IGTA) has emerged as a promising treatment for oligometastatic colorectal lung metastases (CRLM). However, high-quality multicenter data remain limited, and the prognostic impact of site-specific extrapulmonary metastases is not well defined.
AIM
To assess IGTA efficacy in potentially curable oligometastatic CRLM and determine prognostic impacts of extrapulmonary metastatic patterns.
METHODS
This multicenter real-world study analyzed 336 CRLM patients treated with IGTA from 2014 to 2022. Inclusion criteria included pathologically or clinically confirmed oligometastatic CRC, tumor diameter < 50 mm, fewer than 5 metastatic lesions, and ≤ 2 organs involved. Kaplan-Meier and Cox regression methods assessed survival outcomes, including local tumor progression-free survival, progression-free survival (PFS), and overall survival (OS).
RESULTS
The 3-year cumulative local tumor progression rate was 14.0%. Median PFS and OS were 15.6 and 51 months, respectively, with 3- and 5-year OS rates of 59.5% and 41.0%. Poor survival outcomes were associated with a higher tumor burden (larger size and greater number), carcinoembryonic antigen > 20 ng/mL, carbohydrate antigen 19-9 > 37 U/mL, and extrapulmonary metastases. Patients without extrapulmonary metastasis had 1-, 3-, and 5-year PFS rates of 65.4%, 31.0%, and 27.3%, respectively, which were longer than those of CRLM patients with liver metastasis [hazard ratio (HR) = 1.449, P = 0.019] and abdominal cavity metastasis (HR = 1.864, P = 0.010). The 1-, 3-, and 5-year OS rates for patients without extrapulmonary metastasis were 96.4%, 71.0%, and 53.0%, respectively, which were significantly longer than those for patients with bone metastasis (HR = 4.538, P < 0.001), abdominal cavity metastasis (HR = 4.813, P < 0.001), and pelvic cavity metastasis (HR = 3.105, P < 0.001).
CONCLUSION
Metastatic patterns significantly influence PFS and OS, emphasizing the need for careful patient selection. Notably, patients with liver-only extrapulmonary metastasis demonstrate comparatively favorable outcomes, suggesting a distinct biological behavior and better prognosis within this subgroup.
Core Tip: This multicenter study confirms that thermal ablation provides effective local tumor control and meaningful survival benefit in patients with oligometastatic colorectal lung metastases. Importantly, the pattern of extrapulmonary metastasis significantly influences prognosis. Patients with liver-only metastases show comparatively favorable outcomes, underscoring the importance of detailed metastatic pattern assessment in clinical decision-making. Tailoring treatment strategies based on metastatic distribution can optimize patient selection and improve individualized management in oligometastatic colorectal cancer.
