Multicenter and inter-software evaluation of ablative margins after thermal ablation of colorectal liver metastases.

IF 4.7 2区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING European Radiology Pub Date : 2025-02-01 Epub Date: 2024-08-02 DOI:10.1007/s00330-024-10956-5

Gregor Laimer, Koen H M Verdonschot, Lina Kopf, Susan van der Lei, Yannick Scharll, Gerjon Hannink, Sjoerd F M Jenniskens, Martijn R Meijerink, Reto Bale, Christiaan G Overduin

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Abstract

Purpose: To assess the association between minimal ablative margin (MAM) and local tumor progression (LTP) following CT-guided thermal ablation of colorectal liver metastases (CRLM) in a multicenter cohort and across two confirmation software.

Materials and methods: This multicenter retrospective study included patients who underwent CT-guided radiofrequency or microwave ablation for CRLM between 2009 and 2021 in three institutions. Three-dimensional (3D) MAM was retrospectively assessed using dedicated ablation confirmation software by automatic non-rigid (Ablation-fit) or semi-automatic rigid co-registration (SAFIR) of intraprocedural pre- and post-ablation contrast-enhanced CT scans by two independent reader teams blinded to patient outcomes. LTP was assessed on a per-tumor basis. Factors associated with LTP-free survival were assessed using multivariable Cox regression analysis.

Results: Overall, 113 patients (mean age: 67 ± 10 years; 78 men) who underwent thermal ablation for 189 CRLM (mean diameter: 1.9 ± 1.1 cm) met the inclusion criteria. 173/189 (92%) CRLM could be successfully analyzed using both software. Over a median follow-up of 31 months (IQR: 22-47), 21 of 173 CRLM (12.1%) developed LTP. On multivariable analysis, 3D MAM was independently associated with LTP in both software (Ablation-fit: HR 0.47, 95% CI: 0.36-0.61, p < 0.001; SAFIR: HR 0.42, 95% CI: 0.32-0.55, p < 0.001). No LTP was observed in CRLM ablated with MAM ≥ 4 mm (Ablation-fit) and ≥ 5 mm (SAFIR). The per-tumor median absolute difference in MAM quantification between both software was 2 mm (IQR: 1-3).

Conclusion: MAM was independently associated with LTP after thermal ablation of CRLM across multicenter data and two confirmation software. Ablations achieving a MAM ≥ 5 mm were associated with local control in both software.

Clinical relevance statement: MAMs from intraprocedural contrast-enhanced CT were independently associated with LTP after thermal ablation of CRLM across multicenter data and two confirmation software, with a margin ≥ 5 mm associated with local control in both software.

Key points: Sufficient ablative margins are critical for local control following thermal ablation of CRLM. Intraprocedural CT-derived MAM was the only independent factor associated with LTP across two confirmation software. No LTP was observed in CRLM ablated with a MAM ≥ 5 mm.

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对结直肠肝转移灶热消融术后的消融边缘进行多中心和软件间评估。

目的：在一个多中心队列中，通过两个确认软件评估结直肠肝转移瘤（CRLM）CT引导热消融术后最小消融边缘（MAM）与局部肿瘤进展（LTP）之间的关系：这项多中心回顾性研究纳入了2009年至2021年间在三家机构接受CT引导下射频或微波消融治疗CRLM的患者。使用专用的消融确认软件，由两个对患者结果保密的独立阅读团队对术中消融前和消融后对比增强 CT 扫描进行自动非刚性（Ablation-fit）或半自动刚性联合注册（SAFIR），对三维（3D）MAM 进行回顾性评估。LTP以每个肿瘤为单位进行评估。使用多变量考克斯回归分析评估了与无LTP生存相关的因素：共有 113 名患者（平均年龄：67 ± 10 岁；78 名男性）符合纳入标准，他们因 189 个 CRLM（平均直径：1.9 ± 1.1 厘米）接受了热消融治疗。173/189（92%）例 CRLM 均可使用这两种软件进行成功分析。中位随访时间为 31 个月（IQR：22-47），173 个 CRLM 中有 21 个（12.1%）出现了 LTP。在多变量分析中，两种软件中的 3D MAM 均与 LTP 无关（消融拟合：HR 0.47，95% CI：0.36-0.61，P 结论：MAM 与 LTP 无关）：在多中心数据和两种确认软件中，MAM 与 CRLM 热消融后的 LTP 都有独立关联。在两种软件中，MAM ≥ 5 mm 的消融与局部控制有关：在多中心数据和两个确认软件中，术中造影剂增强 CT 显示的 MAM 与 CRLM 热消融后的 LTP 独立相关，在两个软件中，边缘≥ 5 mm 与局部控制相关：要点：CRLM 热消融术后，足够的消融边缘对局部控制至关重要。在两个确认软件中，术中 CT 导出的 MAM 是与 LTP 相关的唯一独立因素。在 MAM ≥ 5 mm 的 CRLM 消融中未观察到 LTP。

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来源期刊

European Radiology 医学-核医学

CiteScore

11.60

自引率

8.50%

发文量

874

审稿时长

2-4 weeks

期刊介绍： European Radiology (ER) continuously updates scientific knowledge in radiology by publication of strong original articles and state-of-the-art reviews written by leading radiologists. A well balanced combination of review articles, original papers, short communications from European radiological congresses and information on society matters makes ER an indispensable source for current information in this field. This is the Journal of the European Society of Radiology, and the official journal of a number of societies. From 2004-2008 supplements to European Radiology were published under its companion, European Radiology Supplements, ISSN 1613-3749.