Thermal ablation with and without adjuvant systemic therapy: a nationwide multicenter observational cohort study of solitary colorectal liver metastases

作者：Jianming Li, Chuan Pang, Guangjian Liu, Xiaoyan Xie, Dezhi Zhang, Kai Li, Zhishuai Li, Guangbin He, Erjiao Xu, Huage Zhong, Yang Hong, Man Lu, Kexin Lou, Xiang Xie, Sirong Lan, Qian Li, Guanghai Dai, Jie Yu, Ping Liang · 发表于：International Journal of Surgery · 年份：2024 · DOI：10.1097/js9.0000000000001397 · 被引用次数：8 · 研究领域：Hepatocellular Carcinoma Treatment and Prognosis、Intraperitoneal and Appendiceal Malignancies、Cholangiocarcinoma and Gallbladder Cancer Studies

BACKGROUND: Thermal ablation is routinely used for solitary colorectal liver metastases (SCLM), but the added value of adjuvant systemic therapy in SCLM remains unclear. This study aimed to compare the long-term outcomes for SCLM treated by ablation alone (AB) versus ablation plus systemic therapy (AS). METHODS: This multicenter retrospective study using nationwide data from fourteen institutions between October 2010 and May 2023, 369 patients with initial SCLM smaller than 5 cm, no extrahepatic metastases, and colorectal cancer R0 resection treated by thermal ablation were included. The crude analysis was used to analyze eligible cases between the two groups. The propensity score matching to control for potential confounders in each matched group. Subgroup analyses were performed to identify specific survival benefits. RESULTS: 61.2% (226/369) of eligible patients were treated with AS and 38.8% (143/369) with AB. During the median follow-up period of 8.8 years, 1-/3-/5-year DFS/OS rates did not differ between the two groups, when analyzed via propensity score matching ( P =0.52/0.08). Subgroup analysis revealed that AS was significantly associated with better OS than AB in patients with plasma CEA >5 ug/l ( P =0.036), T (III-IV) category of primary cancer ( P =0.034), or clinical risk score (1-2) ( P =0.041). In each matched group, the authors did find a significant difference in drug-related adverse events ( P <0.001) between AS group (24.1%, 28/116) and AB group (0.0%, 0/1...