Primary tumour location is an important prognostic factor in colorectal cancer liver metastases following radiofrequency ablation

Evaluation of 3D-CEUS in the Recurrence of Liver Cancer after Radiofrequency Ablation

Background

Radiofrequency ablation (RFA) has the similar curative effects to surgery, but RFA will lead to higher postoperative local recurrence rate. 3D-CEUS is a minimally invasive examination method, which is used to analyze the sensitivity to postoperative recurrence in this study.

Methods

The clinical data of 60 patients with liver cancer admitted to our hospital (February 2018-February 2020) were retrospectively analyzed. All patients were treated with RFA and were followed up with 3D-CEUS, MRI, and enhanced CT examination after surgery. The ROC curve was used to analyze the differences of different examination methods in judging postoperative recurrence.

Results

For the 60 patients, 52 patients (86.7%) had a single lesion and 8 patients (13.3%) had multiple lesions, with a total of 72 lesions. After RFA, 56 lesions (77.8%) were completely inactivated and 16 lesions (22.2%) remained. Totally inactivated lesions were detected as follows: 51 (91.1%) by 3D-CEUS, 42 (75.0%) by MRI, and 50 (89.3%) by enhanced CT. During a 2-year follow-up, a total of 26 recurrent lesions were detected, 24 (92.3%) by 3D-CEUS, 12 (46.2%) by MRI, and 25 (96.2%) by enhanced CT, indicating that the sensitivity of 3D-CEUS and enhanced CT was obviously higher than that of MRI (P < 0.001), without conspicuous difference between sensitivity of 3D-CEUS and enhanced CT (P > 0.05).

Conclusion

As a new imaging examination method based on artificial intelligence, 3D-CEUS has a high sensitivity in patients with liver cancer who underwent RFA, which can effectively judge the recurrence after surgery and should be widely used in practice.

The prognosis of radiofrequency ablation versus hepatic resection for patients with colorectal liver metastases: A systematic review and meta-analysis based on 22 studies

BACKGROUND

Though hepatic resection (HR) is the standard local therapy for patients with colorectal cancer liver metastases (CRLMs), currently, radiofrequency ablation (RFA) may play an alternative role for elderly and vulnerable patients with various organ dysfunctions. This study aims to compare the prognosis of RFA and HR in treatment of CRLMs.

METHODS

A systematic search of PubMed, Embase, Cochrane Library and Web of Science up to October 1, 2020 was conducted for relevant studies that compared the prognosis of RFA with HR in the treatment of CRLMs. The primary outcomes were 30-day mortality, long-term recurrence, overall survival (OS) and disease-free survival (DFS). The secondary outcomes were various factors of OS, recurrence-free survival (RFS), survival, recurrence and complication.

RESULTS

A total of 22 studies including 4385 CRLM patients were identified. There was no significant difference between RFA and HR in 30-day mortality, with a pooled OR of 0.88 (95% CI 0.34-2.29; P = 0.80). CRLM patients undergoing RFA experienced significantly higher incidences of marginal and intrahepatic recurrence than HR, with pooled ORs of 7.09 (95% CI 4.56-11.2; 1251 pts) and 2.02 (95% CI 1.24-3.28; 1038 pts). In addition, RFA showed lower 1-, 3- and 5-yr OS rate than HR with pooled ORs of 0.39, 0.40 and 0.60 respectively. A lower 5-yr DFS rate was also found in RFA than HR group, with a pooled OR of 0.74 (95% CI 0.56-0.97; P = 0.03; 1231 pts). Multivariable analysis showed that tumor size, multiple tumors, age, primary node positive and metachronous metastasis were independent factors of OS, and multiple tumors was also an independent factor of RFS.

CONCLUSIONS

Though the 30-day mortality of RFA was equal to HR, RFA showed a higher recurrence rate and poor long-term survival outcomes for CRLM patients. Tumor size, multiple tumors, age, primary node positive and metachronous metastasis were independent factors of survival. However, the results were limited because of the inequality baseline characteristics between the comparative groups. Randomized or propensity score matching studies should be performed to clarify the effectiveness of RFA and to determine target populations that benefit most from RFA in the future.