Comparison Of Efficacy Of Thermal Ablation And Hepatic Resection In The Colorectal Liver Metastasis

Background and Objective:At present,hepatic resection(HR)is still the first line option for local radical treatment of colorectal cancer with liver metastasis(CRLM).Due to the advantages of minimally invasive,effective,safe,and repeatable thermal ablation(TA),its position in local radical treatment of CRLM is gradually recognized.But TA is usually one of the alternative treatments for unresectable CRLM.There is still controversy over whether TA can replace HR for resectable CRLM.Therefore,this study aims to compare the efficacy of HR and TA in the treatment of resectable CRLM,in order to explore the potential suitability of TA for the population.Methods:This study retrospectively collected the clinicopathological data of 397 patients who received locoregional radical treatment for CRLM from January 2008 to March 2018 in two medical centers of Shandong Provincial Hospital and Shandong Provincial Qianfoshan Hospital,and followed up.Baseline characteristics of the two groups were balanced using 1:1 propensity scoring match(PSM).The survival and recurrence outcomes of the two groups treated with HR and TA were compared,and the risk factors affecting the survival and recurrence of patients with CRLM after radical surgery were discussed.Further subgroup analysis was performed for patients with maximum diameter of liver metastases≤3cm group and 3-5cm group,in order to explore the effect of treatment on long-term survival and recurrence outcome of subgroup patients.Kaplan-Meier method and Log-rank method were used for survival analysis and inter-group test,respectively.Cox regression was used to analyze the risk factors affecting patients’ survival and recurrence.Results:1.Based on the inclusion and exclusion criteria,a total of 230 CRLM patients were included in this study,including 91 in the HR group and 139 in the TA group.After two groups of patients underwent PSM in a 1:1 ratio,the HR and TA groups were matched with 63 CRLM patients,respectively.The median follow-up time for the HR group and the TA group was 63.0(59.5-66.5)months and 92.0(76.9-107.1)months,respectively.2.After PSM,patients in TA group have a lower incidence of postoperative serious complications than those in HR group(1.6%vs.12.7%,P=0.033)and a shorter length of stay(7.0 days vs.14.0 days,P<0.001),and the liver recurrence rate is higher(57.1%vs.33.3%,P=0.012).3.After PSM,the median Disease-free Survival(DFS)of the HR group was 28.0[95%Confidence Interval(CI)12.5-43.5]months.The median DFS of TA group was 11.0[95%CI 3.6-18.4]months(P=0.011).The first,third and five-year DFS rates of HR group and TA group were 64.1%,38.6%,29.2%and 44.0%,27.5%,18.6%,respectively.4.After PSM,the median Overall Survival(OS)was 75.0[95%CI 51.0-99.0]months in the HR group and 50.0[95%CI 26.9-73.1]months in the TA group(P=0.066).The first.third and five-year OS rates of HR group and TA group were 96.2%,72.8%,53.1%and 90.2%,58.0%and 44.4%,respectively.5.Multivariate Cox regression analysis showed that primary tumor lymph node metastasis,multiple liver metastases,and TA treatment were independent risk factors for shortening DFS in CRLM patients;Primary tumor lymph node metastasis,multiple liver metastases,maximum diameter of liver metastases 3-5 cm,and TA treatment are independent risk factors for shortening OS in CRLM patients.6.Subgroup analysis showed that after PSM,there was no statistical difference in DFS and OS between HR group and TA group for patients with the maximum diameter of liver metastases<3cm(P=0.250,P=0.800).For the subgroup of patients with the largest diameter of liver metastases of 3-5cm,there were statistical differences in DFS and OS between the HR group and the TA group(P=0.009,P=0.012).Conclusions:1.In the radical treatment of CRLM,HR has its efficacy advantage over TA for resectable hepatic metastases with a maximum diameter of 3-5cm and the number≤3.However,for resectable liver metastases with the maximum diameter≤3cm and the number≤3,the efficacy of both methods was comparable.Therefore,TA may be considered as a first-line treatment option for patients with resectable CRLM whose maximum diameter is ≤3cm and number<3.2.Multivariate Cox regression analysis indicated that lymph node metastases of primary tumor,multiple metastases,maximum diameter of metastatic tumor 3-5 cm and TA were independent risk factors for shortening OS.Primary tumor lymph node metastasis,multiple liver metastases,maximum diameter of liver metastases 3-5 cm,and TA treatment are independent risk factors for shortening OS in CRLM patients.