1. 高雄長庚 大腸直腸外科 吳昆霖 盧建璋, 陳鴻華, 李克釗, 胡萬祥, 張家駱, 蔡鎧隆, 林岳民, 鄭功全
台灣外科醫學會107年度聯合學術演講會
Prognostic Factors of Radiofrequency Ablation Therapy for Liver Metastases from Colorectal Cancer
高雄長庚 大腸直腸外科
吳昆霖
盧建璋, 陳鴻華, 李克釗, 胡萬祥, 張家駱, 蔡鎧隆, 林岳民, 鄭功全

2. Introduction
Majority of CRC related deaths attributed to metastatic disease.
Liver is the most common site of distal metastasis.
Surgical resection of liver metastasis from CRC produce long- term survival
Only 10~20% P’t are candidate at the time of presentation.

3. Radiofrequency ablation(RFA) achieve higher complete necrosis of metastatic lesions then other local ablative technique.
Promising tool to expand criteria of resectability or treatment strategy for post hepatectomy.
Limited data on recurrences and survival after RFA for CRC liver metastasis.

4. Materials and Methods
Single tertiary center, retrospective study, 2008/06~2013/12 colorectal cancer with liver metastasis patient.
Exclusion criteria: Tumor with vascular invasion or coagulopathy(Plt<50K/uL or INR>1.5)

5. All p’t received chemotherapy in pre- or post- RFA stage.
Percutaneous or intraOP RFA combine with hepatectomy
Primary technical success absence of target tumor contrast enhancement on CT scan 1 month after treatment.

6. Results 52 p’t (34 Men/ 18 Women) Mean age: 62.5 years.
Main tumor median size: 2.5cm
Detection of liver metastasis: synchronous: 25; metachronous: 27
Percutaneous: 33; intraOP RFA plus hepatectomy: 19
Median follow-up time: 24 months

7. No procedure related deaths. Primary technical success: 45/52 (87%)
Tumor number:
Solitary:14
2-3 tumors: 15
> 3 tumors: 23

8. Primary success+
(n=45)
Primary success-
(n=7)
p-value
Age (years)
61.9 ± 12.0
67.0 ± 13.3
0.308
Male / Female
28 / 17
6 / 1
0.399
Body mass index (kg/m2)
24.0 ± 3.6
23.6 ± 2.6
0.807
Type 2 diabetes mellitus (%)
15 / 30
3 / 4
0.682
Synchronous / Metachronous
22 / 23 1
CEA >=10 /< 10 ng/ml
21 / 23
4 / 3
0.703
Main RFA tumor >3 /<3 cm
8 / 37
5 / 2
0.008
Tumor number <=3 / >3
1 / 6
0.035
RFA / RFA plus resection
29 / 16
0.697

9. Local recurrence free survival

10. New tumor recurrence free survival

11. Overall survival OS at 1,2,and 3 year after RFA: 87%, 61, and 46%.
9/19(47%) deaths related with liver tumor prograssion

12. Multivariate analysis
Hazard ratio
95% CI
p-value
Survival
Age < 60 years
2.825
0.043
CEA > 10 ng/ml
6.456
0.005
Local recurrence-free
Primary success
7.489
0.001
New recurrence-free
Tumor number <=3
3.220
0.004

13. Discussion

14. In literature, Surgical resection v. s
In literature, Surgical resection v.s. RFA in therapeutic success surgical group have better result with 3-y survival 55~82% than 22~53% in RFA.
Local recurrent rate of percutaneous and open RFA ranged from 9~42% and 5~14%
In our study, the outcomes were not different in RFA alone and intraOP RFA plus resection  suggest our percutaneous RFA still achieve good primary success rate, and as a effective alternative for unresectable liver lesions.

15. Factors associated with local recurrence were reported as large lesion size, close to large vessels, inadequate treatment margin  our study: primary treatment success
Intrahepatic new recurrence after RFA was around 44% in literature.
In our study, multinodularity metastasis with total tumor number > 3 could predict higher incidence of new recurrence. high risk of unrecognize “micro-metastasis” at diagnosis

16. Previous study indicate poor predictors for undergoing resection liver metastasis from CRC
Positive margin
Extrahepatic disease
Primary Nodal positive
Disease free interval <12 months
>1 hepatic tumors
Largest tumor > 5cm
CEA > 200ng/mL
Ann surg 1999; 230:

17. In our study, young age (<60 years) (HR 2
In our study, young age (<60 years) (HR 2.82) and high CEA level (>10 ng/ml) (HR 6.456) were independent factors with poor overall survival
Relationship of young age and poor survival remains unclear poor tumor biology or delayed diagnosis? some study indicate opposite opinion
 further large-scale prospective studies are still mandatory to clarify these issues.

18. Conclusion
Our study shows RFA is an effective and safe treatment modality for colorectal liver metastases.
In some patients, combined resection and intraOP RFA can increase the possibility of curative therapy.
Young age and high CEA level predict poor outcomes after RFA for colorectal liver metastases.