倾向性评分匹配法比较手术切除与微波消融治疗结直肠癌肝转移疗效
|
摘要
目的:探讨手术切除与微波消融治疗结直肠癌肝转移(CRLM)的疗效比较。方法:回顾自2010-2016年的329例CRLM患者临床资料,经倾向性评分匹配,共分析75例手术切除治疗与75例微波消融治疗的术后并发症、局部肿瘤进展率、无病生存率、总生存率。结果:中位随访期为42月(范围14～72月)。对肝内单发病灶(直径≤3 cm)和肝内多发病灶(n≤3,直径≤3 cm)的患者,局部肿瘤进展率、总生存率在切除组与消融组间没有显著差异(P=0.355,P=0.503)。对肝内多发病灶(n≤3,直径>3 cm)和肝内多发病灶(n>3)者,局部肿瘤进展率消融组高于手术切除组(P=0.033),总生存率消融组少于切除组(P=0.042)。结论:手术切除治疗结直肠癌肝转移优于微波消融。但对于肝内单发病灶(直径≤3 cm)和肝内多发病灶(n≤3,直径≤3 cm)的CRLM患者,微波消融可以达到与手术切除相媲美的治疗效果。
Objective:To compare the curative effect of surgical resection and microwave ablation in the treatment of liver metastasis of colorectal cancer(CRLM).M ethods:From 2010 to 2016, the clinical data of 329 patients with CRLM were reviewed. The postoperative complications, local tumor pro-gression rate, disease-free survival rate and overall survival rate were analyzed in 75 cases of surgical resection and 75 cases of microwave ablation.R esults:The median follow-up period was 42 months(range 14-72 months). There were no significant differences in the hepatic single lesions(less than 3 cm in diameter) and multiple liver lesions(n=3, less than 3 cm in diameter), local tumor progression and overall survival rate between the resection group and ablation group(P=0.355, P=0.503). For multiple liver lesions(n=3, diameter>3 cm, or n>3), local tumor progression rate of ablation group was higher than that of the surgical resection group(P=0.033), while the total survival rate of abla-tion group was less than the resection group(P=0.042).C o nc lu sio n :Surgical resection is superior to microwave ablation in the treatment of liver metastasis of colorectal cancer. But for intrahepatic soli-tary lesions(less than 3 cm in diameter) and multiple liver lesions(n≤3, less than 3 cm in diameter),microwave ablation and surgical resection can achieve comparable treatment effect.
Objective:To compare the curative effect of surgical resection and microwave ablation in the treatment of liver metastasis of colorectal cancer(CRLM).M ethods:From 2010 to 2016, the clinical data of 329 patients with CRLM were reviewed. The postoperative complications, local tumor pro-gression rate, disease-free survival rate and overall survival rate were analyzed in 75 cases of surgical resection and 75 cases of microwave ablation.R esults:The median follow-up period was 42 months(range 14-72 months). There were no significant differences in the hepatic single lesions(less than 3 cm in diameter) and multiple liver lesions(n=3, less than 3 cm in diameter), local tumor progression and overall survival rate between the resection group and ablation group(P=0.355, P=0.503). For multiple liver lesions(n=3, diameter>3 cm, or n>3), local tumor progression rate of ablation group was higher than that of the surgical resection group(P=0.033), while the total survival rate of abla-tion group was less than the resection group(P=0.042).C o nc lu sio n :Surgical resection is superior to microwave ablation in the treatment of liver metastasis of colorectal cancer. But for intrahepatic soli-tary lesions(less than 3 cm in diameter) and multiple liver lesions(n≤3, less than 3 cm in diameter),microwave ablation and surgical resection can achieve comparable treatment effect.
引文
[1]Takahashi M,Hasegawa K,Oba M,et al.Repeat resection leads to long-term survival:analysis of 10-year follow-up of patients with colorectal liver metastases[J].Am J Surg,2015,210:904-910.
[2]Schiergens TS,von Einem J,Thomas MN,et al.Multidisciplinary treatment of colorectal liver metastases[J].Minerva Med,2017,108:527-546.
[3]Yu J,Yu XL,Han ZY,et al.Percutaneous cooled-probe microwave versus radiofrequency ablation in earlystage hepatocellular carcinoma:a phaseⅢrandomised controlled tria[l J].Gut,2017,66(6):1 172-1 173.
[4]Li M,Li Z,Yu X,et al.Percutaneous radio-frequency ablation of hepatocellular carcinoma adjacent to the gastrointestinal tract[J].Int J Hyperthermia,2016,32(6):600-606.
[5]Chiang J,Cristescu M,Lee MH,et al.Effects of microwave ablation on arterial and venous vasculature after treatment of hepatocellular carcinoma[J].Radiology,2016,281(2):617-624.
[6]Lee DH,Lee JM,Kang TW,et al.Clinical outcomes of radiofrequency ablation for early hypovascular HCC:A Multicenter Retrospective Study[J].Radiology,2018,286(1):338-349.
[7]Mayo SC,Pawlik TM.Thermal ablative therapies for secondary hepatic malignancies[J].Cancer J,2010,16:111-117.
[8]Groeschl RT,Pilgrim CH,Hanna EM,et al.Microwave ablation for hepatic malignancies:a multiinstitutional analysis[J].Ann Surg,2014,259:1 195-1 200.
[9]Kallini JR,Gabr A,Abouchaleh N,et al.New developments in interventional oncology:liver metastases from colorectal cancer[J].Cancer J,2016,22:373-380.
[10]Odisio BC,Yamashita S,Huang SY,et al.Impact of prior hepatectomy history on local tumor progression after percutaneous ablation of colorectal liver metastases[J].J Vasc Interv Radiol,2018,29:395-403.e391.
[11]Takahashi H,Kahramangil B,Berber E.Local recurrence after microwave thermosphere ablation of malignant liver tumors:results of a surgical series[J].Surgery,2018,163(4):709-713.
[12]Lorentzen T,Skjoldbye BO,Nolsoe CP.Microwave ablation of liver metastases guided by contrast-enhanced ultrasound:experience with 125 metastases in 39 patients[J].Ultraschall in der Medizin,2011,32:492-496.
[13]盛立军,宋孙,郭亚.微波消融与手术切除结直肠癌肝转移的疗效比较[J].中国微创外科杂志,2015,15(10):887-890.Sheng LJ,Song S,Guo Y.Microwave ablation versus surgical resection of colorectal cancer liver metastasis:Comparison of clinical efficacy[J].Chinese Journal of Minimally Invasive Surgery,2015,15(10):887-890.
[14]李兴华.微波消融与手术切除结直肠癌肝转移疗效比较[J].吉林医学,2017,38(6):1 092-1 093.Li XH.Comparison of microwave ablation and surgical resection for liver metastases from colorectal cancer[J].Jilin Medical Journal,2017,38(6):1 092-1 093.
[15]Dindo D,Demartines N,Clavien PA.Classification of surgical complications:a new proposal with evaluation in a cohort of 6 336 patients and results of a survey[J].Ann Surg,2004,240:205-213.
[16]Timmerman RD,Bizekis CS,Pass HI,et al.Local surgical,ablative,and radiation treatment of metastases[J].CA Cancer J Clin,2009,59(3):145-170.
[17]Katrina F.Chu DED.Thermal ablation of tumours biological mechanisms and advances in therapy[J].Nat Rev Cancer,2014,14:199-208.
[18]Ahmed M,Solbiati L,Brace CL,et al.Image-guided tumor ablation:standardization of terminology and reporting criteria-a 10-year update[J].Radiology,2014,273(1):241-260.
[19]徐金顺,李攀,王志刚.超声引导下经皮微波消融治疗肝癌的研究进展[J].中国介入影像与治疗学,2014,11(9):15-18.Xu JS,Li P,Wang ZG.Progresses in ultrasound’guided percutaneous microwave ablation of hepatic malignancy[J].Chinese Journal of Interventional Imaging and Therapy,2014,11(9):15-18.
[20]Yu J,Liang P.Status and advancement of microwave ablation in China[J].Int J Hyperthermia,2016,20:1-10.
[21]Ierardi AM,Floridi C,Fontana F,et al.Microwave ablation of liver metastases to overcome the limitations of radiofrequency ablation[J].Radiol Med,2013,118:949-961.
[22]Poulou LS,Thanos L,Ziakas PD,et al.Thermal ablation may improve outcomes in patients with colorectal liver metastasis:a case-control study[J].J BUON,2017,22:673-678.
[23]Wu YZ,Li B,Wang T,et al.Radiofrequency ablation vs hepatic resection for solitary colorectal liver metastasis:a meta-analysis[J].World J Gastroenterol,2011,17:4 143-4 148
[24]Mayo SC,Pawlik TM.Thermal ablative therapies for secondary hepatic malignancies[J].Cancer J,2010,16:111-117.
[25]Correa-Gallego C,Fong Y,Gonen M,et al.A retrospective comparison of microwave ablation vs.radiofrequency ablation for colorectal cancer hepatic metastases[J].Ann Surg Oncol,2014,21:4 278-4 283.
[26]Song P,Sheng L,Sun Y,et al.The clinical utility and outcomes of microwave ablation for colorectal cancer liver metastases[J].Oncotarget,2017,8(31):51 792-51 799.
[2]Schiergens TS,von Einem J,Thomas MN,et al.Multidisciplinary treatment of colorectal liver metastases[J].Minerva Med,2017,108:527-546.
[3]Yu J,Yu XL,Han ZY,et al.Percutaneous cooled-probe microwave versus radiofrequency ablation in earlystage hepatocellular carcinoma:a phaseⅢrandomised controlled tria[l J].Gut,2017,66(6):1 172-1 173.
[4]Li M,Li Z,Yu X,et al.Percutaneous radio-frequency ablation of hepatocellular carcinoma adjacent to the gastrointestinal tract[J].Int J Hyperthermia,2016,32(6):600-606.
[5]Chiang J,Cristescu M,Lee MH,et al.Effects of microwave ablation on arterial and venous vasculature after treatment of hepatocellular carcinoma[J].Radiology,2016,281(2):617-624.
[6]Lee DH,Lee JM,Kang TW,et al.Clinical outcomes of radiofrequency ablation for early hypovascular HCC:A Multicenter Retrospective Study[J].Radiology,2018,286(1):338-349.
[7]Mayo SC,Pawlik TM.Thermal ablative therapies for secondary hepatic malignancies[J].Cancer J,2010,16:111-117.
[8]Groeschl RT,Pilgrim CH,Hanna EM,et al.Microwave ablation for hepatic malignancies:a multiinstitutional analysis[J].Ann Surg,2014,259:1 195-1 200.
[9]Kallini JR,Gabr A,Abouchaleh N,et al.New developments in interventional oncology:liver metastases from colorectal cancer[J].Cancer J,2016,22:373-380.
[10]Odisio BC,Yamashita S,Huang SY,et al.Impact of prior hepatectomy history on local tumor progression after percutaneous ablation of colorectal liver metastases[J].J Vasc Interv Radiol,2018,29:395-403.e391.
[11]Takahashi H,Kahramangil B,Berber E.Local recurrence after microwave thermosphere ablation of malignant liver tumors:results of a surgical series[J].Surgery,2018,163(4):709-713.
[12]Lorentzen T,Skjoldbye BO,Nolsoe CP.Microwave ablation of liver metastases guided by contrast-enhanced ultrasound:experience with 125 metastases in 39 patients[J].Ultraschall in der Medizin,2011,32:492-496.
[13]盛立军,宋孙,郭亚.微波消融与手术切除结直肠癌肝转移的疗效比较[J].中国微创外科杂志,2015,15(10):887-890.Sheng LJ,Song S,Guo Y.Microwave ablation versus surgical resection of colorectal cancer liver metastasis:Comparison of clinical efficacy[J].Chinese Journal of Minimally Invasive Surgery,2015,15(10):887-890.
[14]李兴华.微波消融与手术切除结直肠癌肝转移疗效比较[J].吉林医学,2017,38(6):1 092-1 093.Li XH.Comparison of microwave ablation and surgical resection for liver metastases from colorectal cancer[J].Jilin Medical Journal,2017,38(6):1 092-1 093.
[15]Dindo D,Demartines N,Clavien PA.Classification of surgical complications:a new proposal with evaluation in a cohort of 6 336 patients and results of a survey[J].Ann Surg,2004,240:205-213.
[16]Timmerman RD,Bizekis CS,Pass HI,et al.Local surgical,ablative,and radiation treatment of metastases[J].CA Cancer J Clin,2009,59(3):145-170.
[17]Katrina F.Chu DED.Thermal ablation of tumours biological mechanisms and advances in therapy[J].Nat Rev Cancer,2014,14:199-208.
[18]Ahmed M,Solbiati L,Brace CL,et al.Image-guided tumor ablation:standardization of terminology and reporting criteria-a 10-year update[J].Radiology,2014,273(1):241-260.
[19]徐金顺,李攀,王志刚.超声引导下经皮微波消融治疗肝癌的研究进展[J].中国介入影像与治疗学,2014,11(9):15-18.Xu JS,Li P,Wang ZG.Progresses in ultrasound’guided percutaneous microwave ablation of hepatic malignancy[J].Chinese Journal of Interventional Imaging and Therapy,2014,11(9):15-18.
[20]Yu J,Liang P.Status and advancement of microwave ablation in China[J].Int J Hyperthermia,2016,20:1-10.
[21]Ierardi AM,Floridi C,Fontana F,et al.Microwave ablation of liver metastases to overcome the limitations of radiofrequency ablation[J].Radiol Med,2013,118:949-961.
[22]Poulou LS,Thanos L,Ziakas PD,et al.Thermal ablation may improve outcomes in patients with colorectal liver metastasis:a case-control study[J].J BUON,2017,22:673-678.
[23]Wu YZ,Li B,Wang T,et al.Radiofrequency ablation vs hepatic resection for solitary colorectal liver metastasis:a meta-analysis[J].World J Gastroenterol,2011,17:4 143-4 148
[24]Mayo SC,Pawlik TM.Thermal ablative therapies for secondary hepatic malignancies[J].Cancer J,2010,16:111-117.
[25]Correa-Gallego C,Fong Y,Gonen M,et al.A retrospective comparison of microwave ablation vs.radiofrequency ablation for colorectal cancer hepatic metastases[J].Ann Surg Oncol,2014,21:4 278-4 283.
[26]Song P,Sheng L,Sun Y,et al.The clinical utility and outcomes of microwave ablation for colorectal cancer liver metastases[J].Oncotarget,2017,8(31):51 792-51 799.