| Purpose:Surgical resection is the only recognized treatment that can bring long-term survival or even cure for patients with colorectal liver metastasis(CRLM).Radiofrequency ablation(RFA)has achieved satisfactory effects in unresectable CRLMs.However,RFA for resectable CRLMs is still controversial.Previous studies are all retrospective studies and most of the studies have the problem of large differences in baseline levels between RFA group and surgical resection group.At present,there are no randomized controlled clinical trials to prove the clinical effect of radiofrequency ablation for resectable CRLMs.The purpose of this study was to compare the efficacy of RFA and surgical resection in patients with CRLMs with the maximum diameter of liver metastases ≤ 3cm and the number of metastases ≤ 3 at similar baseline levels.We also analyses the risk factors of recurrence after treatment in patients with CRLMs.Methods:The demographic,clinical,pathological and imaging features of 97 patients with CRLMs who underwent radical resection or radiofrequency ablation of liver metastases in Tianjin Medical University Cancer Hospital from 2012 to 2016 were analyzed retrospectively.According to the treatment,the patients were divided into surgical resection group(n=74)and RFA group(n=23).The clinicopathological information of the two groups was entered into SPSS,to compare the recurrence rates and survival rates between the two groups.Cox regression model was used to analyze the risk factors of recurrence.The therapeutic effects of radiofrequency ablation and surgical resection on CRLMs with liver metastasis ≤ 2cm were compared.In addition,the therapeutic effect of radiofrequency ablation on liver metastasis with diameter ≤ 2cm or 2-3cm was also compared.Results:In the resection group,the median recurrence-free survival time was 16.0 months,and the 1-year and 2-year recurrence-free survival rates were 54.6% and 39.0% respectively.The median recurrence-free survival time in RFA group was 9.5 months,and the 1-year and 2-year recurrence-free survival rates were was 39.1% and 8.7% respectively.There was significant difference between the two groups(P ≤ 0.003).There was no significant difference in local recurrence rate and system recurrence rate between the two groups,but the intrahepatic recurrence rate in radiofrequency ablation group was higher than that in surgical resection group.The median overall survival time in the resection group was 55.4 months,which was better than that in the RFA group(35.3 months).The 1-,3-and 5-year survival rates of surgical resection group and RFA group were 90.5% vs 95.7%,65.9% vs 39.5% and 48.1% vs 33.9%,respectively,but the difference was not statistically significant(P≤0.06).Multivariate analysis showed that radiofrequency ablation of liver metastases,node-positive primary and simultaneous liver metastasis were independent risk factors for recurrence.RFA of liver metastases is the most significant independent risk factor.Subgroup analysis showed that patients with liver metastasis diameter ≤ 2cm,The 1-year and 2-year recurrence-free survival rates in radiofrequency ablation group were still lower than those in surgical resection group(45.5% vs 49.3%,9.1% vs 37.7%),but the difference was not statistically significant(P ≥ 0.170).The 1-,3-and 5-year survival rates of the two groups were similar(90.9% vs 88.9%,53.0% vs 56.5%,39.8% vs 46.6%,P ≤ 0.681).There was no significant difference in recurrence-free survival rate and overall survival rate between patients with liver metastases ≤ 2cm or 2-3cm treated by RFA.Conclusions:RFA can achieve the effect of complete ablation in CRLMs with diameter ≤ 3cm,but the recurrence rate is still higher than that of surgical resection,and adequate preoperative imaging examination should be used.Radiofrequency ablation of liver metastases,lymph node metastasis of primary toumor and simultaneous liver metastasis are independent risk factors for recurrence of CRLM after treatment. |
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