TY - JOUR
T1 - Ablation of colorectal liver metastasis
T2 - Interaction of ablation margins and RAS mutation profiling on local tumour progression-free survival
AU - Calandri, Marco
AU - Yamashita, Suguru
AU - Gazzera, Carlo
AU - Fonio, Paolo
AU - Veltri, Andrea
AU - Bustreo, Sara
AU - Sheth, Rahul A.
AU - Yevich, Steven M.
AU - Vauthey, Jean Nicolas
AU - Odisio, Bruno C.
N1 - Publisher Copyright:
© 2018, European Society of Radiology.
PY - 2018/7/1
Y1 - 2018/7/1
N2 - Objectives: To investigate effects of ablation margins on local tumour progression-free survival (LTPFS) according to RAS status in patients with colorectal liver metastases (CLM). Methods: This two-institution retrospective study from 2005–2016 included 136 patients (91 male, median age 60 years) with 218 ablated CLM. LTPFS was performed using the Kaplan–Meier method and evaluated with the log-rank test. Uni/multivariate analyses were performed using Cox-regression models. Results: Three-year LTPFS rates for CLM with minimal ablation margin ≤10 mm were significantly worse than those with >10 mm in both mutant-RAS (29% vs. 48%, p=0.038) and wild-type RAS (70% vs. 94%, p=0.039) subgroups. Three-year LTPFS rates of mutant-RAS were significantly worse than wild-type RAS in both CLM subgroups with minimal ablation margin ≤10 mm (29% vs. 70%, p<0.001) and >10 mm (48% vs. 94%, p=0.006). Predictors of worse LTPFS were ablation margins ≤10 mm (HR: 2.17, 95% CI 1.2–4.1, p=0.007), CLM size ≥2 cm (1.80, 1.1–2.8, p=0.017) and mutant-RAS (2.85, 1.7–4.6, p<0.001). Conclusions: Minimal ablation margin and RAS status interact as independent predictors of LTPFS following CLM ablation. While minimal ablation margins >10 mm should be always the procedural goal, this becomes especially critical for mutant-RAS CLM. Key Points: • RAS and ablation margins are predictors of local tumour progression-free survival. • Ablation margin >10 mm, always desirable, is crucial for mutant RAS metastases. • Interventional radiologists should be aware of RAS status to optimize LTPFS.
AB - Objectives: To investigate effects of ablation margins on local tumour progression-free survival (LTPFS) according to RAS status in patients with colorectal liver metastases (CLM). Methods: This two-institution retrospective study from 2005–2016 included 136 patients (91 male, median age 60 years) with 218 ablated CLM. LTPFS was performed using the Kaplan–Meier method and evaluated with the log-rank test. Uni/multivariate analyses were performed using Cox-regression models. Results: Three-year LTPFS rates for CLM with minimal ablation margin ≤10 mm were significantly worse than those with >10 mm in both mutant-RAS (29% vs. 48%, p=0.038) and wild-type RAS (70% vs. 94%, p=0.039) subgroups. Three-year LTPFS rates of mutant-RAS were significantly worse than wild-type RAS in both CLM subgroups with minimal ablation margin ≤10 mm (29% vs. 70%, p<0.001) and >10 mm (48% vs. 94%, p=0.006). Predictors of worse LTPFS were ablation margins ≤10 mm (HR: 2.17, 95% CI 1.2–4.1, p=0.007), CLM size ≥2 cm (1.80, 1.1–2.8, p=0.017) and mutant-RAS (2.85, 1.7–4.6, p<0.001). Conclusions: Minimal ablation margin and RAS status interact as independent predictors of LTPFS following CLM ablation. While minimal ablation margins >10 mm should be always the procedural goal, this becomes especially critical for mutant-RAS CLM. Key Points: • RAS and ablation margins are predictors of local tumour progression-free survival. • Ablation margin >10 mm, always desirable, is crucial for mutant RAS metastases. • Interventional radiologists should be aware of RAS status to optimize LTPFS.
KW - Ablation techniques
KW - Colorectal neoplasms
KW - DNA mutational analysis
KW - Interventional radiology
KW - Metastasis
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U2 - 10.1007/s00330-017-5273-2
DO - 10.1007/s00330-017-5273-2
M3 - Article
C2 - 29417253
AN - SCOPUS:85041495196
SN - 0938-7994
VL - 28
SP - 2727
EP - 2734
JO - European Radiology
JF - European Radiology
IS - 7
ER -