Thermal Ablation Compared to Partial Hepatectomy for Recurrent Colorectal Liver Metastases: An Amsterdam Colorectal Liver Met Registry (AmCORE) Based Study
Abstract
:Simple Summary
Abstract
1. Introduction
2. Materials and Methods
2.1. Patient Selection
2.2. Repeat Local Treatment Procedures
2.3. Follow-Up
2.4. Data Collection and Statistical Analysis
3. Results
3.1. Patient Characteristics
3.2. Treatment Characteristics
3.3. Complications
3.4. Local Tumor Progression-Free Survival
3.5. Distant Progression-Free Survival
3.6. Overall Survival
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
18F-FDG | [18F]-fluoro-2-deoxy-D-glucose |
AmCORE | Amsterdam Colorectal Liver Met Registry |
ASA | American Society of Anesthesiologists score |
BMI | Body mass index |
COLLISION | Colorectal Liver Metastases: Surgery vs. Thermal Ablation |
Ce | Contrast-enhancement |
CI | Confidence interval |
CRC | Colorectal cancer |
CRLM | Colorectal liver metastases |
CT | Computed tomography |
CTCAE | Common Terminology Criteria for Adverse Events |
DPFS | Distant progression-free survival |
HR | Hazard ratio |
IRE | Irreversible electroporation |
IQR | Interquartile range |
LTP | Local tumor progression |
LTPFS | Local tumor progression-free survival |
MRI | Magnetic resonance imaging |
MWA | Microwave ablation |
OS | Overall survival |
PET | Positron emission tomography |
RCT | Randomized controlled trial |
RFA | Radiofrequency ablation |
SBRT | Stereotactic body radiation therapy |
SD | Standard deviation |
STROBE | Strengthening the Reporting of Observational studies in Epidemiology |
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Total | Repeat Thermal Ablation Group | Repeat Resection Group | p-Value | ||
---|---|---|---|---|---|
Number of patients | 136 | 100 (73.5) | 36 (26.5) | ||
Number of tumors | 224 | 170 (75.9) | 54 (24.1) | ||
Patient Characteristics | |||||
Gender | Male | 104 (76.5) | 79 (79.0) | 25 (69.4) | |
Female | 32 (23.5) | 21 (21.0) | 11 (30.6) | 0.259 a | |
Age (years) * | 66.0 (10.9) | 66.9 (11.4) | 63.3 (9.1) | 0.092 c | |
ASA physical status | 1 | 8 (5.9) | 7 (7.0) | 1 (2.8) | |
2 | 93 (68.4) | 67 (67.0) | 26 (72.2) | ||
3 | 35 (25.7) | 26 (26.0) | 9 (25.0) | 0.632 b | |
Comorbidities | None | 67 (49.3) | 47 (47.0) | 20 (55.6) | |
Minimal | 49 (36.0) | 38 (38.0) | 11 (30.6) | ||
Major | 20 (14.7) | 15 (15.0) | 5 (13.9) | 0.663 b | |
BMI (kg/cm2) * | 26.1 (4.2) | 26.4 (4.2) | 25.0 (4.0) | ||
Missing | 3 | 0 | 3 | 0.094 c | |
Primary tumor location | Rectum | 33 (24.3) | 22 (22.0) | 11 (30.6) | |
Colon left-sided | 67 (49.3) | 50 (50.0) | 17 (47.2) | ||
Colon right-sided | 36 (26.5) | 28 (28.0) | 8 (22.2) | 0.556 b | |
Characteristics Initial Local Treatment of CRLM | |||||
Initial CRLM diagnosis | Synchronous | 69 (51.9) | 51 (52.6) | 18 (50.0) | |
Metachronous | 64 (48.1) | 46 (47.4) | 18 (50.0) | 0.847 a | |
Missing | 3 | 3 | 0 | ||
Number of tumors | 1 | 38 (27.9) | 26 (26.0) | 12 (33.3) | |
2–5 | 65 (47.8) | 45 (45.0) | 20 (55.6) | ||
>5 | 33 (24.3) | 29 (29.0) | 4 (11.1) | 0.099 b | |
Size of largest metastasis (mm) | Small (1–30) | 75 (62.5) | 57 (61.3) | 18 (66.7) | |
Intermediate (31–50) | 36 (30.0) | 28 (30.1) | 8 (29.6) | ||
Large (>50) | 9 (7.5) | 8 (8.6) | 1 (3.7) | 0.681 b | |
Missing | 16 | 7 | 9 | ||
Extrahepatic disease | No | 111 (92.5) | 82 (93.2) | 29 (90.6) | |
Yes | 9 (7.5) | 6 (6.8) | 3 (9.4) | 0.699 a | |
Missing | 16 | 12 | 4 | ||
Type of procedure | Resection | 44 (32.4) | 27 (27.0) | 17 (47.2) | |
Thermal ablation | 43 (31.6) | 35 (35.0) | 8 (22.2) | ||
Resection and thermal ablation | 46 (33.8) | 37 (37.0) | 9 (25.0) | ||
IRE | 2 (1.5) | 1 (1.0) | 1 (2.8) | ||
SBRT | 1 (0.7) | 0 (0.0) | 1 (2.8) | 0.057 b | |
Characteristics Repeat Local Treatment of CRLM | |||||
Time between initial treatment and diagnosis recurrence (months) * | 6.9 (4.0–13.4) | 6.4 (4.0–10.4) | 12.2 (3.7–21.3) | 0.056 d | |
Number of tumors | 1 | 85 (62.5) | 59 (59.0) | 26 (72.2) | |
2–5 | 50 (36.8) | 40 (40.0) | 10 (27.8) | ||
>5 | 1 (0.7) | 1 (1.0) | 0 (0) | 0.337 b | |
Size of largest metastasis (mm) | Small (1–30) | 100 (84.7) | 80 (85.1) | 20 (83.3) | |
Intermediate (31–50) | 16 (13.6) | 13 (13.8) | 3 (12.5) | ||
Large (>50) | 2 (1.7) | 1 (1.1) | 1 (4.2) | 0.572 b | |
Missing | 18 | 6 | 12 | ||
Chemotherapy | No | 98 (72.1) | 71 (71.0) | 27 (75.0) | |
Yes | 38 (27.0) | 29 (29.0) | 9 (25.0) | 0.829 a |
Repeat Thermal Ablation Group n = 100 | Repeat Resection Group n = 36 | ||
---|---|---|---|
Type of repeat thermal ablation | RFA | 40 (40.0) | - |
Le VeenTM | 35 (35.0) | ||
Cool-tipTM | 4 (4.0) | ||
Others | 1 (1.0) | ||
MWA | 60 (60.0) | - | |
EmprintTM | 46 (46.0) | ||
Covidien EvidentTM | 5 (5.0) | ||
Others | 9 (9.0) | ||
Type of repeat resection | Minor (<3 segments) | - | 34 (97.1) |
Major (≥3 segments) | - | 1 (2.9) | |
Missing | 2 | ||
Approach | Open | 17 (17.2%) | 28 (84.8) |
Laparoscopic | 0 (0.0) | 5 (15.2) | |
Percutaneous | 82 (82.2%) | - | |
Missing | 1 | 3 |
Grade | Total | Repeat Thermal Ablation Group n = 100 | Repeat Resection Group n = 36 | p-Value |
---|---|---|---|---|
None | 97 (78.2) | 80 (80.8) | 17 (68.0) | 0.063 b |
Grade 1 | 8 (6.5) | 8 (8.1) | NR | |
Grade 2 | 8 (6.5) | 4 (4.0) | 4 (16.0) | |
Grade 3 | 9 (7.3) | 6 (6.1) | 3 (12.0) | |
Grade 4 | 2 (16) | 1 (1.0) | 1 (4.0) | |
Grade 5 | NR | NR | NR | |
Missing | 12 | 1 | 11 |
Univariable Analysis | Multivariable Analysis | ||||
---|---|---|---|---|---|
HR (CI) | p-Value | HR (CI) | p-Value | ||
Repeat local treatment | Repeat resection | Reference | 0.927 | Reference | 0.966 |
Repeat thermal ablation | 0.971 (0.515–1.831) | 0.986 (0.517–1.881) | |||
Patient-Related Factors | |||||
Gender | Male | Reference | 0.593 | ||
Female | 0.826 (0.409–1.668) | ||||
Age (years) | 1.027 (0.994–1.062) | 0.114 | |||
ASA physical status | 1 | Reference | 0.177 | ||
2 | 3.790 (0.894–16.078) | ||||
3 | 2.979 (0.644–13.780) | ||||
Comorbidities | None | Reference | 0.038 | Reference | 0.038 |
Minimal | 1.615 (0.853–3.061) | 1.618 (0.850–3.079) | |||
Major | 2.940 (1.264–6.838) | 2.936 (1.258–6.848) | |||
BMI (kg/cm2) | 0.978 (0.906–1.056) | 0.570 | |||
Primary tumor location | Rectum | Reference | 0.084 | Reference | 0.060 |
Colon left-sided | 0.902 (0.434–1.877) | 0.879 (0.421–1.835) | |||
Colon right-sided | 1.918 (0.862–4.268) | 2.002 (0.890–4.503) | |||
Factors Regarding Initial Local Treatment of CRLM | |||||
Initial CRLM diagnosis | Synchronous | Reference | 0.778 | ||
Metachronous | 0.917 (0.503–1.672) | ||||
Number of tumors | 1 | Reference | 0.618 | ||
2–5 | 0.906 (0.465–1.764) | ||||
>5 | 0.663 (0.287–1.535) | ||||
Size of largest metastasis (mm) | Small (1–30) | Reference | 0.349 | ||
Intermediate (31–50) | 0.864 (0.438–1.706) | ||||
Large (>50) | 0.333 (0.075–1.478) | ||||
Extrahepatic disease | No | Reference | 0.250 | ||
Yes | 0.311 (0.042–2.277) | ||||
Type of procedure | Resection | Reference | 0.798 | ||
Thermal ablation | 1.360 (0.669–2.765) | ||||
Resection andthermal ablation | 0.867 (0.413–1.822) | ||||
IRE | 1.128 (0.147–8.645) | ||||
SBRT | * | ||||
Factors regarding repeat local treatment of CRLM | |||||
Time between initial treatment and diagnosis recurrence (months) | 1.001 (0.980–1.022) | 0.943 | |||
Number of tumors | 1 | Reference | 0.620 | ||
2–5 | 1.350 (0.740–2.464) | ||||
>5 | * | ||||
Size of largest metastasis (mm) | Small (1–30) | Reference | 0.251 | ||
Intermediate (31–50) | 1.795 (0.812–3.971) | ||||
Large (>50) | 2.092 (0.481–9.103) | ||||
Chemotherapy | No | Reference | 0.825 | ||
Yes | 1.071 (0.582–1.970) |
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Dijkstra, M.; Nieuwenhuizen, S.; Puijk, R.S.; Timmer, F.E.F.; Geboers, B.; Schouten, E.A.C.; Opperman, J.; Scheffer, H.J.; Vries, J.J.J.d.; Swijnenburg, R.-J.; et al. Thermal Ablation Compared to Partial Hepatectomy for Recurrent Colorectal Liver Metastases: An Amsterdam Colorectal Liver Met Registry (AmCORE) Based Study. Cancers 2021, 13, 2769. https://doi.org/10.3390/cancers13112769
Dijkstra M, Nieuwenhuizen S, Puijk RS, Timmer FEF, Geboers B, Schouten EAC, Opperman J, Scheffer HJ, Vries JJJd, Swijnenburg R-J, et al. Thermal Ablation Compared to Partial Hepatectomy for Recurrent Colorectal Liver Metastases: An Amsterdam Colorectal Liver Met Registry (AmCORE) Based Study. Cancers. 2021; 13(11):2769. https://doi.org/10.3390/cancers13112769
Chicago/Turabian StyleDijkstra, Madelon, Sanne Nieuwenhuizen, Robbert S. Puijk, Florentine E.F. Timmer, Bart Geboers, Evelien A.C. Schouten, Jip Opperman, Hester J. Scheffer, Jan J.J. de Vries, Rutger-Jan Swijnenburg, and et al. 2021. "Thermal Ablation Compared to Partial Hepatectomy for Recurrent Colorectal Liver Metastases: An Amsterdam Colorectal Liver Met Registry (AmCORE) Based Study" Cancers 13, no. 11: 2769. https://doi.org/10.3390/cancers13112769
APA StyleDijkstra, M., Nieuwenhuizen, S., Puijk, R. S., Timmer, F. E. F., Geboers, B., Schouten, E. A. C., Opperman, J., Scheffer, H. J., Vries, J. J. J. d., Swijnenburg, R.-J., Versteeg, K. S., Lissenberg-Witte, B. I., van den Tol, M. P., & Meijerink, M. R. (2021). Thermal Ablation Compared to Partial Hepatectomy for Recurrent Colorectal Liver Metastases: An Amsterdam Colorectal Liver Met Registry (AmCORE) Based Study. Cancers, 13(11), 2769. https://doi.org/10.3390/cancers13112769