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热消融与手术切除治疗异时性结直肠癌肝转移的临床疗效比较

Comparison of Clinical Efficacy of Thermal Ablation vs. Surgical Resection of Metachronous Colorectal Liver Metastasis

    摘要
  • 摘要:
      目的  比较热消融与手术切除治疗异时性结直肠癌肝转移（colorectal liver metastasis, CRLM）的疗效，探讨热消融的潜在合适人群。
      方法  回顾性收集2007年11月–2021年1月在中国医学科学院肿瘤医院接受根治性治疗的319例CRLM患者资料，根据治疗方法的不同，分为热消融组和手术切除组。运用倾向性评分匹配（propensity scoring match, PSM）平衡患者基线资料。运用Cox回归分析确定影响患者复发及生存的危险因素。两组间进行生存分析。
      结果  按照1∶1比例，PSM后热消融组和手术切除组各匹配92例患者。热消融组中位总生存时间为49（95%置信区间37～76）个月，短于手术切除组（P<0.01）。多因素Cox回归分析提示原发肿瘤T分期、转移瘤数目、转移瘤最大直径、术前血清癌胚抗原水平及治疗方式是影响总生存时间的独立危险因素。与手术切除组相比，热消融组肝脏复发率较高（59.8% vs. 23.9%，P<0.01），无病生存期较短（10个月 vs. 33个月，P<0.01），但住院时间更短（7.0 d vs. 14.0 d，P<0.01）。亚组分析使用匹配前的319例样本进行，显示早期复发的患者接受热消融和手术切除的中位总生存期相当（29个月 vs. 42个月，P=0.35）；非早期复发的患者接受热消融治疗的中位总生存期短于手术切除组（P<0.01）。
      结论  手术切除CRLM的疗效优于热消融治疗，但在早期复发患者中两者疗效相当。

     

    Abstract:
      Objective  To compare the treatment efficacy of thermal ablation versus surgical resection of metachronous colorectal liver metastasis (CRLM) and to explore the potential candidates suited for thermal ablation.
      Methods  The data of 319 patients with CRLM who underwent radical treatment at the Cancer Hospital, Chinese Academy of Medical Sciences between November 2007 and January 2021 were retrospectively collected. The patients were divided into two groups, the thermal ablation group and the surgical resection group, according to the actual treatments they received. Propensity score matching (PSM) was applied to balance the baseline characteristics between the two groups. Cox regression analysis was conducted to identify the risk factors for recurrence and survival. Survival analysis was performed for intergroup comparison.
      Results  Using PSM at 1∶1 ratio, 92 patients were included in the thermal ablation group and 92 patients were included in the surgical resection group.The median overall survival (OS) in the thermal ablation group was 49 (95% confidence interval, 37-76) months, which was shorter than that of the surgical resection group (P<0.01). Multivariate Cox regression analysis indicated that the T staging of primary tumor, number of metastatic tumor, maximum diameter of metastatic tumor, preoperative serum carcinoembryonic antigen (CEA) level, and treatment method were independent risk factors affecting OS. Compared with the surgical resection group, the thermal ablation group demonstrated higher hepatic recurrence rate (59.8% vs. 23.9%, P<0.01), shorter disease-free survival (DFS) (10 months vs. 33 months, P<0.01), and shorter length of hospital stay (7 days vs. 14 days, P<0.01). Subgroup analysis, conducted with the data of the 319 patients before PSM, showed that early recurrence patients who underwent thermal ablation or surgical resection had comparable median OS (29 months vs. 42 months, P=0.35). For the non-early recurrence patients, the median OS of the thermal ablation group was shorter than that of the surgical resection group (P<0.01).
      Conclusion  For the treatment of CRLM, the efficacy of surgical resection was better than that of thermal ablation. However, the efficacy was comparable between the two treatments for early recurrence patients of CRLM.

     

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