Abstract
Regrowth after ablation is common, but predictive factors for local control are scarce. This study investigates whether histopathological growth patterns (HGP) can be used as a predictive biomarker for local control after ablation of colorectal liver metastases (CRLM). Patients who received simultaneous resection and ablation as first treatment for CRLM between 2000 and 2019 were considered eligible. HGPs were determined on resected CRLM according to international guidelines and were classified as desmoplastic or non-desmoplastic. As minimal inter-tumoural heterogeneity has been demonstrated, the HGP of resected and ablated CRLM were presumed to be identical. Local tumour progression (LTP) was assessed on postoperative surveillance imaging. Uni- and multivariable competing risk methods were used to compare LTP. In total 221 patients with 443 ablated tumours were analysed. A desmoplastic HGP was found in 60 (27.1%) patients who had a total of 159 (34.7%) ablated lesions. Five-year LTP [95%CI] was significantly higher for ablated CRLM with a presumed non-desmoplastic HGP (37% [30-43] vs 24% [17-32], Gray's-test p=0.014). On multivariable analysis, a non-desmoplastic HGP (adjusted HR [95%CI]; 1.55 [1.03-2.35]) was independently associated with higher LTP rates after ablation. HGP is an independent predictor of local tumour progression following ablation of CRLM.
Highlights
Colorectal cancer (CRC) is one of the most prevalent solid malignancies in the world, with an estimated 1,8 million people affected each year.[1]
Baseline characteristics A total of 306 patients who received combined ablation and resection as surgical treatment for colorectal liver metastases (CRLM) were evaluated in this study
To the best of our knowledge, this study is the first to assess the effect of histopathological growth patterns (HGP) on local tumour control after ablation of CRLM
Summary
Colorectal cancer (CRC) is one of the most prevalent solid malignancies in the world, with an estimated 1,8 million people affected each year.[1]. There are multiple treatment modalities, such as chemotherapy, resection, and ablation which can prolong survival outcomes in patients with unresectable CRLM.[5]. Local treatment with either ablation or surgical resection, offers the only potential for cure in patients with CRLM.[6]. Local regrowth occurs in 10%–40% of patients after ablation and in 4%–17% of patients after resection of CRLM.[9,10,14–19]. This study investigates whether histopathological growth patterns (HGP) can be used as a predictive biomarker for local control after ablation of colorectal liver metastases (CRLM). Five-year LTP [95%CI] was significantly higher for ablated CRLM with a presumed non-desmoplastic HGP (37% [30–43] vs 24% [17–32], Gray’s-test p = 0.014). A non-desmoplastic HGP (adjusted HR [95% CI]; 1.55 [1.03–2.35]) was independently associated with higher LTP rates after ablation. Conclusion: HGP is an independent predictor of local tumour progression following ablation of CRLM
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