Int J Gastrointest Interv.  2023 Jul;12(3):130-139. 10.18528/ijgii230019.

Long-term results of radiofrequency and microwave ablation of colorectal cancer liver metastasis

• Erdemir AG
• Karahan S
• Ünal E
• Çiftçi TT
• Akıncı D
• Yalçın Ş
• Akhan O

• KMID: 2545063
• DOI: http://doi.org/10.18528/ijgii230019

Abstract

Background
Radiofrequency ablation (RFA) or microwave ablation (MWA) is effective for colorectal cancer liver metastases. We aimed to investigate the impact of different variables on survival.
Methods
Sixty-four patients (142 lesions) who underwent thermoablation between January 2007 and January 2019 were retrospectively analyzed. The overall survival (OS) and liver progression-free survival (Li-PFS) were compared using Kaplan-Meier analysis. Univariable and multivariable Cox-regression were done to identify prognostic factors.
Results
No significant difference was found between median OS (59.39 months) and Li-PFS (41.22 months) of patients who received MWA (n = 33); and median OS (61.00 months) and Li-PFS (53.43 months) of patients who received RFA (n = 31) (OS: P = 0.697; Li-PFS: P = 0.122). The median OS and Li-PFS were significantly decreased with lung metastases and K-ras mutations (P < 0.001). There was no correlation between prior systemic chemotherapy (n = 25) and both outcome parameters (OS: P = 0.613; Li-PFS: P = 0.665). No significant difference was observed in patients with lesions less than 30 mm diameter (n = 44) whether they received prior systemic chemotherapy (n = 17) or not (n = 27) (OS: P = 0.27; Li-PFS: P = 0.42). Similarly, in patients with a lesion of 3–5 cm diameter (n = 20; eight of them had prior chemotherapy), there was no correlation for both outcomes (OS: P = 0.069; Li-PFS: P = 0.71). The most important prognostic factor was concomitant lung metastases (hazard ratio = 3.689, P = 0.002).
Conclusion
Concomitant lung metastasis and mutant K-ras were associated with shorter survival. Survival did not differ significantly regarding thermoablation technique or prior systemic chemotherapy. However, in the patient group with lung metastases, curative treatments had better survival than patients who received chemotherapy only. Additional therapeutic options should be considered in patients with concomitant lung metastasis.

Keyword

Ablation techniques; Colorectal neoplasms; Drug therapy; Genes, ras; Survival analysis