3D Quantitative Ablation Margins for Prediction of Ablation Site Recurrence After Stereotactic Image-Guided Microwave Ablation of Colorectal Liver Metastases: A Multicenter Study.

Simeon J S Ruiter,Stefan Weber,Jacob Freedman,Daniel Candinas,Jennie Engstrand,Robbert J De Haas,Pascale Tinguely,Iwan Paolucci,Koert P De Jong

doi:10.3389/fonc.2021.757167

Abstract

BackgroundThree-dimensional (3D) volumetric ablation margin assessment after thermal ablation of liver tumors using software has been described, but its predictive value on treatment efficacy when accounting for other factors known to correlate ablation site recurrence (ASR) remains unknown.PurposeTo investigate 3D quantitative ablation margins (3D-QAMs) as an algorithm to predict ASR within 1 year after stereotactic microwave ablation (SMWA) for colorectal liver metastases (CRLM).Materials and MethodsSixty-five tumors in 47 patients from a prospective multicenter study of patients undergoing SMWA for CRLM were included in this retrospective 3D-QAM analysis. Using a previously developed algorithm, 3D-QAM defined as the distribution of tumor to ablation surface distances was assessed in co-registered pre- and post-ablation CT scans. The discriminatory power and optimal cutoff values for 3D-QAM were assessed using receiver operating characteristic (ROC) curves. Multivariable logistic regression analysis using generalized estimating equations was applied to investigate the impact of various 3D-QAM outputs on 1-year ASR while accounting for other known influencing factors.ResultsTen of the 65 (15.4%) tumors included for 3D-QAM analysis developed ASR. ROC analyses identified i) 3D-QAM <1 mm for >23% of the tumor surface, ii) 3D-QAM <5 mm for >45%, and iii) the minimal ablation margin (MAM) as the 3D-QAM outputs with optimal discriminatory qualities. The multivariable regression model without 3D-QAM yielded tumor diameter and KRAS mutation as 1-year ASR predictors. When adding 3D-QAM, this factor became the main predictor of 1-year ASR [odds ratio (OR) 21.67 (CI 2.48, 165.21) if defined as >23% <1 mm; OR 0.52 (CI 0.29, 0.95) if defined as MAM].Conclusions3D-QAM allows objectifiable and standardized assessment of tumor coverage by the ablation zone after SMWA. Our data shows that 3D-QAM represents the most important factor predicting ASR within 1 year after SMWA of CRLM.

Highlights

Thermal ablation such as microwave ablation (MWA) is a tissuesparing treatment alternative to hepatic resection in selected patients, yielding similar treatment efficacy, recurrence-free survival, and overall survival as described in non-randomized studies [1,2,3,4,5]
The aim of the present study was to acquire further knowledge on predictors of ablation site recurrence (ASR) after stereotactic microwave ablation (SMWA) of colorectal liver metastases (CRLM) by i) investigating three-dimensional quantitative ablation margin (3D-QAM) as a predictor of 1-year ASR, considering factors previously shown to be negatively correlated with ASR, and ii) identifying and comparing different outputs of 3D quantitative ablation margins (3D-QAMs) and their effect sizes in a multivariable model in data from a prospective European multicenter trial
Median tumor diameter was 13 mm (IQR 10–20 mm), with two tumors treated with a diameter above 30 mm (34 and 41 mm) due to tumor growth between date of patient inclusion and date of SMWA

Summary

Introduction

Thermal ablation such as microwave ablation (MWA) is a tissuesparing treatment alternative to hepatic resection in selected patients, yielding similar treatment efficacy, recurrence-free survival, and overall survival as described in non-randomized studies [1,2,3,4,5]. The main remaining drawback of thermal ablation is the relatively frequent suspicion of viable tumor tissue at the edge of the ablation zone [ablation site recurrence (ASR)] reported between 2% and 41% for colorectal liver metastases (CRLM) [8, 9]. The correlation of volumetric ablation margins with ASR, while taking into account other previously described independent predictors of ASR, has not yet been investigated [16, 19,20,21]. Three-dimensional (3D) volumetric ablation margin assessment after thermal ablation of liver tumors using software has been described, but its predictive value on treatment efficacy when accounting for other factors known to correlate ablation site recurrence (ASR) remains unknown. Purpose: To investigate 3D quantitative ablation margins (3D-QAMs) as an algorithm to predict ASR within 1 year after stereotactic microwave ablation (SMWA) for colorectal liver metastases (CRLM)

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