Gao SQ, Zhang BW, Zhao QY, Jiang TA. Repeat ablation and single-session ablation in patients with multiple colorectal cancer liver metastases after chemotherapy failure. World J Gastroenterol 2025; 31(43): 111494 [DOI: 10.3748/wjg.v31.i43.111494]
Corresponding Author of This Article
Tian-An Jiang, Professor, Senior Researcher, Department of Ultrasound, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun Road, Hangzhou 310003, Zhejiang Province, China. tiananjiang@zju.edu.cn
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
Si-Qi Gao, Qi-Yu Zhao, Tian-An Jiang, Department of Ultrasound, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
Bo-Wen Zhang, Department of Radiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
Co-first authors: Si-Qi Gao and Bo-Wen Zhang.
Author contributions: Gao SQ and Zhang BW conducted the formal analysis and investigation, made equal contributions as co-first authors; Jiang TA contributed to conceptualization and acquired funding; Jiang TA and Zhao QY developed the methodology; Gao SQ prepared the original draft; Zhang BW undertaken review and editing; all authors have read and approved the final manuscript.
Supported by National Natural Science Foundation of China, No. 82027803 and No. 81971623; and Key Research and Development Project of Zhejiang Province, No. 2024C03092.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of The First Affiliated Hospital, Zhejiang University School of Medicine, No. IIT20241080A.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to biopsy and treatment by written consent.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The datasets generated during the current study are available from the first author and corresponding author on 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: Tian-An Jiang, Professor, Senior Researcher, Department of Ultrasound, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun Road, Hangzhou 310003, Zhejiang Province, China. tiananjiang@zju.edu.cn
Received: July 2, 2025 Revised: August 24, 2025 Accepted: October 21, 2025 Published online: November 21, 2025 Processing time: 141 Days and 17.1 Hours
Abstract
BACKGROUND
The feasibility and safety of radiofrequency ablation (RFA) for oligometastatic colorectal liver metastases (CRLM) have been well established. However, the role of RFA in multiple metastases after first-line chemotherapy failure remains underexplored.
AIM
To assess long-term survival and factors affecting outcomes of RFA in patients with multiple refractory CRLM.
METHODS
A retrospective study was conducted on patients who underwent ablation of CRLM at our institution between January 2015 and June 2024. A total of 80 patients were included, with 42 individuals receiving single-session ablation and 38 underwent repeat ablation. Enhanced computed tomography imaging was utilized to evaluate procedural efficacy 24 hours post-RFA, followed by follow-up scans every 3-4 months. Progression-free survival (PFS) and overall survival (OS) rates were compared at endpoint using Kaplan-Meier curves. Cox regression was used to identify the factors associated with OS and PFS.
RESULTS
The technical success rate was recorded at 98.7%. At endpoint, 42 (52.5%) patients achieved tumor-free survival, while 28 (35%) remained alive with residual tumors present. No significant OS/PFS differences existed between single-session (median follow-up 29.5 months, median PFS 24.5 months) and repeat ablation (30 months, 14 months) cohorts (P > 0.05). Multivariate analysis showed that larger tumor size (P < 0.001) and older age (P = 0.01) were associated with worse OS. The median PFS was 13.5 months, with tumor size emerging as the only independent predictor (P = 0.04).
CONCLUSION
For patients with multiple refractory CRLM, both single-session ablation and repeat ablation can increase the proportion of patients achieving tumor-free status. However, careful consideration is necessary for ablation of metastases larger than 2.7 cm.
Core Tip: This is a retrospective study to investigate long-term survival and factors affecting outcomes of radiofrequency ablation in patients with multiple refractory colorectal liver metastases after systemic chemotherapy failure. No significant differences emerged in overall survival or progression-free survival when comparing single-session with repeat ablation. Nevertheless, supplemental or additional ablation sessions appeared to improve the likelihood of patients attaining a tumor-free status, suggesting a potential benefit in refractory colorectal liver metastases.
