Potential for cure and predictors of long-term survival after radiofrequency ablation for colorectal liver metastases: A 20-years single-center experience. Issue 12 (December 2022)

• Record Type: Journal Article
• Authors: Weilert, Hauke; Sadeghi, Darja; Lipp, Michael; Oldhafer, Karl Jürgen; Donati, Marcello; Stang, Axel
• Is Part Of: European journal of surgical oncology. Volume 48:Issue 12(2022)
• Page Start: 2487
• Page End: 2494
• Publication Date: 2022-12
• Subjects: Colorectal liver metastases -- Radiofrequency ablation -- KRAS mutation -- BRAF mutation -- Long-term survival -- Cure; BRAF B-Raf and v-Raf murine sarcoma viral oncogene homolog B -- CEA Carcinoembyonic antigen -- CECT Contrast-enhanced computed tomography -- CRLM Colrectal liver metastases -- KRAS Kirsten rat sarcoma virus -- OS Overall survival -- PD Progressive disease -- PR Partial remisssion -- RECIST Response evaluation criteria in solid tumours -- RFA Radiofrequency ablation -- RFS Recurrence-free survival; Oncology -- Periodicals; Cancer -- Surgery -- Periodicals; Medical Oncology -- Periodicals; Neoplasms -- surgery -- Periodicals; Cancer -- Chirurgie -- Périodiques; Cancérologie -- Périodiques; Oncologie; Chirurgie (geneeskunde); Electronic journals; Electronic journals -- Sciences; Electronic journals -- Medicine; Electronic journals; 616.994059005
• DOI: 10.1016/j.ejso.2022.06.010
• Languages: English
• ISSNs: 0748-7983

Abstract

Abstract: Background: Additional radiofrequency ablation (RFA) of liver-limited colorectal liver metastases (CRLM) improves overall (OS) and recurrence-free survival (RFS) over systemic therapy alone. We aimed to assess the potential and predictive factors of long-term survival and cure to optimize patient selection for RFA application. Methods: Retrospective review of a prospectively maintained single-center database of consecutive patients undergoing RFA for liver-limited CRLM after systemic therapy between 2002 and 2020. Clinicopathologic characteristics and KRAS/BRAF- genotype data (tested routinely since 2010) were correlated to RFS and OS. Cure was defined as ≥10-years RFS (long-term survival as ≥5-years OS) following RFA. Results: For the entire cohort of 158 patients (median follow-up 13.6 years), co-occurrence of three factors, RECIST-defined response, number of ≤3 CRLM, and ≤3 cm maximum size determined a survival plateau that distinguished cured from non-cured patients (10-years RFS: 15.5% vs 0%, p < 0.0001). Among 59 patients (37.3%) being tested, 4(6.8%) were BRAF -mt, 15(25.4%) KRAS -mt, and 40(67.8%) KRAS/BRAF -wt. OS (median follow-up 8.3 years) was estimated to be higher with KRAS/BRAF -wt compared to a mutant KRAS or BRAF status (5-years OS: 22.8% vs 3.4%, p = 0.0018). Conclusion: This study indicates about 15% chance of cure following RFA of low-volume liver-limited CRLM after downsizing by systemic therapy and a negative effect of KRAS or BRAF mutation on long-term survival after CRLM ablation. These findings may improve clinical decision-making in patients potentially candidate to RFA of CRLM and encourage further investigations on molecular factors determining an oligometastatic state of CRLM curable with focal ablative therapy.