Published online Sep 15, 2020. doi: 10.4251/wjgo.v12.i9.1044
Peer-review started: May 6, 2020
Revised: June 21, 2020
Accepted: August 15, 2020
Article in press: August 15, 2020
Published online: September 15, 2020
Processing time: 126 Days and 17.9 Hours
Colorectal cancer liver metastasis (CRLM) is a common secondary malignant tumor of the liver and an important cause of tumor-related death. Radiofrequency ablation (RFA) is an accepted alternative therapy for CRLM patients who are unsuitable for resection. However, the relatively high rate of local tumor progression (LTP) is an obstacle to the more widespread use of RFA.
We want to identify the group of CRLM patients who benefit most from RFA, and to provide a reference framework for personalized treatment strategies.
This study aimed to determine the oncological outcomes of RFA in CRLM patients, and to assess predictors that affect LTP-free survival (LTPFS) and overall survival (OS).
A retrospective study was conducted. One hundred and thirty-eight lesions in 85 consecutive CRLM patients received RFA treatment from January 2013 to December 2018. Contrast-enhanced computed tomography was performed the first month after RFA to serve as a baseline for subsequent evaluations. The Kaplan-Meier method was used to calculate OS and LTPFS. Univariate and multivariate analyses were performed to determine the predictors of the oncological outcomes.
There were no RFA procedure-related deaths, and the technique effectiveness rate of the treatment was 89.1% (123/138). The median OS was 36 mo, and the 1-, 3-, and 5-year OS rates were 90.6%, 45.6%, and 22.9%, respectively. Tumor size larger than 3 cm and ablative margin of 5 mm or smaller were the independent predictors of shorter LTPFS, while tumor number greater than 1, size larger than 3 cm, and presence of extrahepatic disease (EHD) were the independent predictors of shorter OS.
RFA is a safe and effective treatment method for CRLM. Tumor size and ablative margin are the important factors affecting LTPFS, while tumor number, tumor size, and EHD are also critical factors in OS.
RFA is an effective minimally invasive treatment that can be used as an alternative for patients with unresectable CRLM. Expanding the ablative margin is an effective method to control LTP after RFA. Patients with a single tumor, size of 3 cm or smaller, and no EHD benefit most from RFA.