Immediate post-thermal ablation biopsy of colorectal liver metastases to predict oncologic outcomes.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 4602-4602
Author(s):  
Nikiforos Vasiniotis Kamarinos ◽  
Efsevia Vakiani ◽  
Mithat Gonen ◽  
Nancy E. Kemeny ◽  
Anne M. Covey ◽  
...  
Keyword(s):  
Liver Metastases ◽  
Tumor Cells ◽  
Tumor Size ◽  
Thermal Ablation ◽  
Colorectal Liver Metastases ◽  
Univariate Analysis ◽  
Contrast Material ◽  
Maximum Diameter ◽  
Minimal Risk ◽  
Viable Tumor

4602 Background: Thermal ablation (TA) is used as a local cure for selected colorectal liver metastases (CLM) with minimal risk. A critical limitation of TA has been early local tumor progression (LTP). The goal of this study is to establish the role of ablation zone (AZ) biopsy in predicting LTP. Methods: This institutional review board-approved prospective study included patients with CLM of 5cm or less in maximum diameter, with confined liver disease or stable, limited extrahepatic disease. Both radiofrequency(RF) and microwave(MW) ablation modalities were used. A biopsy of the center and margin of the AZ was performed immediately after ablation. The applicators were also examined for the presence of viable tumor cells. All samples containing morphologically identified tumor cells were further interrogated with immunohistochemistry to determine the proliferative and viability potential of the detected tumor cells. Ablation margin size was evaluated on the first CT scan performed 4–8 weeks after ablation and was confirmed by 3D assessment with Ablation Confirmation Software (Neuwave™). Variables were evaluated as predictors of time to LTP with the competing-risks model (uni- and multivariate analyses). Results: Between November 2009 and February 2019, 102 patients with 182 CLMs were enrolled. Mean tumor size was 2.0 cm (range, 0.6–4.8 cm). MW was used in 95/182 (52%) tumors and RF in 87/182 (48%). Median follow-up was 19 months. Technical effectiveness was evident in 178/182 (97%) ablated tumors on the first contrast material–enhanced CT at 4–8-weeks post-ablation. The cumulative incidence of LTP at 12 months was 19% (95% confidence interval [CI]: 14, 27). Samples from 64 (35%) of the 178 technically successful cases contained viable tumor. At univariate analysis, tumor size, minimal margin size, and biopsy results were significant in predicting LTP. In a multivariate model, margin size of less than 5 mm (P < .001; hazard ratio [HR], 4.3), and positive biopsy results (P = .02; HR, 1.8) remained significant. LTP within 12 months after TA was noted in 3% (95% CI: 1, 6) of tumor-negative biopsy CLMs with margins of at least 5 mm. Conclusions: Biopsy and pathologic examination of the AZ predicts LTP regardless of TA modality used. This can optimize ablation as a potential local cure for patients with limited CLM.

Altered growth patterns of colorectal liver metastases after thermal ablation

Surgery ◽  
2006 ◽  
Vol 139 (1) ◽  
pp. 73-81 ◽  
Author(s):  
Mehrdad Nikfarjam ◽  
Vigayaragavan Muralidharan ◽  
Christopher Christophi
Keyword(s):  
Liver Metastases ◽  
Thermal Ablation ◽  
Colorectal Liver Metastases ◽  
Growth Patterns

Comparison of Total Tumor Volume, Size and Number of Colorectal Liver Metastases in Prediction of Survival in Patients after Liver Resection

2015 ◽  
Vol 87 (2) ◽  
Author(s):  
Wacław Hołówko ◽  
Michał Grąt ◽  
Karolina Maria Wronka ◽  
Jan Stypułkowski ◽  
Rafał Roszkowski ◽  
...  
Keyword(s):  
Overall Survival ◽  
Liver Resection ◽  
Liver Metastases ◽  
Predictive Value ◽  
Colorectal Liver Metastases ◽  
Tumor Volume ◽  
Univariate Analysis ◽  
Total Tumor Volume ◽  
Right Hemihepatectomy ◽  
Volume Size

AbstractLiver is the most common location of the colorectal cancer metastases occurrence. Liver resection is the only curative method of treatment. Unfortunately it is feasible only in 25% of patients with colorectal liver metastases, often because of the extensiveness of the disease.The aim of the study was to evaluate the predictive value of total tumor volume, size and number of colorectal liver metastases in patients treated with right hemihepatectomy.Material and methods. A retrospective analysis was performed in a group of 135 patients with colorectal liver metastases, who were treated with right hemihepatectomy. Total tumor volume was estimated based on the formula (4/3)πr3. Moreover, the study included an analysis of data on the number and size of tumors, radicality of the resection, time between primary tumor resection and liver resection, pre-operative blood serum concentration of carcinoembryonal antigen (CEA) and carcinoma antigen Ca19-9. The predictive value of the factors was evaluated by applying a Cox proportional hazards model and the area under the ROC curve.Results. The univariate analysis has shown the predictive value of size of the largest tumor (p=0.033; HR=1.065 per each cm) on the overall survival, however no predictive value of number of tumors (p=0.997; HR=1.000) and total tumor volume (p=0.212; HR=1.002) was observed. The multivariate analysis did not confirm the predictive value of the size of the largest tumor (p=0.141; HR=1.056). In the analysis of ROC curves, AUROC for the total tumor volume, the size of the largest tumor and the number of tumors were 0.629, 0.608, 0.520, respectively.Conclusions. Total tumor volume, size and number of liver metastases are not independent risk factors for the worse overall survival of patients with colorectal liver metastases treated with liver resection, therefore increased values of these factors should not be a contraindication for surgical treatment

scholarly journals Survival Impact of Primary Tumor Lymph Node Status and Circulating Tumor Cells in Patients with Colorectal Liver Metastases

2017 ◽  
Vol 24 (8) ◽  
pp. 2113-2121 ◽  
Author(s):  
Lars Thomas Seeberg ◽  
Cathrine Brunborg ◽  
Anne Waage ◽  
Harald Hugenschmidt ◽  
Anne Renolen ◽  
...  
Keyword(s):  
Lymph Node ◽  
Liver Metastases ◽  
Tumor Cells ◽  
Circulating Tumor Cells ◽  
Primary Tumor ◽  
Colorectal Liver Metastases ◽  
Lymph Node Status ◽  
Node Status

A clinical prognosis model for Asian advanced melanoma patients receiving immunotherapy.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e14081-e14081
Author(s):  
Xuan Wang ◽  
Xieqiao Yan ◽  
Zhihong Chi ◽  
Lu Si ◽  
Xinan Sheng ◽  
...  
Keyword(s):  
Risk Factors ◽  
Liver Metastases ◽  
Tumor Size ◽  
Cox Model ◽  
Univariate Analysis ◽  
Advanced Melanoma ◽  
Braf Mutations ◽  
Clinical Prognosis ◽  
C Statistic ◽  
Melanoma Patients

e14081 Background: Immunotherapy PD-1 inhibitor therapy shows relative lower efficacy in Asia especially in acral and mucosal subtypes. The identification of predictive factors of immunotherapy remains a crucial but unmet clinical need. The objective of this study was to evaluate advanced melanoma patients treated with anti-PD-1 in order to identify risk factors for PFS, OS and develop a prognostic scoring system for immunotherapy. Methods: Patients with unresectable melanoma treated with PD-1 inhibitor enrolled on trials between 2015 and 2017 at Peking University Cancer Center were included. A nomogram to predict survival was developed based on a multivariable Cox model. The predictive performance of the model was assessed according to the C-statistic, Kaplan–Meier curve and calibration plots. Results: The discovery cohort comprised 133 patients with unresectable melanoma. 38.3% acral and 21.8% mucosal melanomas were included, 26.3% with liver metastases, 31.6% with an elevated serum LDH, 20.3% harbored BRAF mutations. The median PFS was 4.8 months, based on the Cox model, four factors were selected for the nomogram and assigned specific scores: tumor metastases number≥3, 1; tumor size≥80 mm,1; LDH level, 1 (higher limit of normal range); liver metastases,1. The model achieved relatively good discrimination and calibration, with a C-statistic of 0⋅804 (Table). BRAF mutations were associated with shorter PFS in univariate analysis but not in multivariate analysis. Subtypes were also not related to PFS in this cohort. The median OS was 22.8 months. Univariate analysis identified eight factors were associated with significantly worse OS among 21 factors ( BRAF and subtype included, which not found as risk factors). Based on the Cox model, five factors were selected for the nomogram and assigned specific scores: ECOG > 1, 0.6; Hemoglobin < 120g/ml,0.6; tumor size≥80 mm,1.4; LDH level, 0.5; liver metastases, 1. C-statistic was 0⋅85, with extremely strong predictability (Table). The overall survival rate for patients with a higher score was significantly worse than lower cohort (Score: < 0.6 vs. 1-2 vs. 2-4.1; OS: not reached vs. not reached vs. 8.3m; P < 0⋅001). Conclusions: The nomogram facilitates personalized assessment of prognosis for Asian patients with advanced melanoma with PD-1 inhibitor. [Table: see text]

Recurrence after Complete Cryoablation of Colorectal Liver Metastases: Analysis of Prognostic Features

2006 ◽  
Vol 72 (5) ◽  
pp. 382-390
Author(s):  
Tristan D. Yan ◽  
David R. Nunn ◽  
David L. Morris
Keyword(s):  
Liver Metastases ◽  
Colorectal Liver Metastases ◽  
Multivariate Analyses ◽  
Univariate Analysis ◽  
Disease Free Survival ◽  
Free Survival ◽  
Prognostic Features ◽  
Observational Cohort ◽  
Disease Free

This study critically evaluated the prognostic determinants for disease-free survival (DFS) after cryoablation for colorectal liver metastases. An observational cohort study of prospectively collected data on 135 patients who underwent cryoablation with or without resection for colorectal liver metastases was performed. Univariate and multivariate analyses were used to determine the prognostic factors for overall DFS, cryosite DFS, remaining liver DFS, and extrahepatic DFS. Overall, 115 patients (85%) developed recurrence at the cryosite (44%), and the remaining patients developed recurrence at the liver (62%) and extrahepatic site (71%). In univariate analysis, pre-operative and postoperative carcinoembryonic antigen (CEA) were significant for overall DFS. Distribution of metastases, operation type, total number of metastases, number of cryotreated metastases, largest size of cryotreated metastasis, and postoperative CEA were significant for cryosite DFS. The number of cryotreated metastases and postoperative CEA were significant for remaining liver DFS. The largest size of cryotreated metastasis, and preoperative and postoperative CEA were significant for extrahepatic DFS. In multivariate analysis, resection plus cryoablation, ≤7 liver metastases and ≤3 cm cryotreated metastasis were independently associated with an improved cryosite DFS. Preoperative CEA of ≤5 ng/mL was independently associated with an improved overall and extrahepatic DFS. The role of CEA in colorectal metastasis is important. Resection plus cryoablation rather than cryoablation alone should be used for larger lesions.

scholarly journals Systematic review of thermal ablation techniques for resectable colorectal liver metastases

HPB ◽  
2020 ◽  
Vol 22 ◽  
pp. S268
Author(s):  
M. Di Martino ◽  
G. Rompianesi ◽  
I. Mora-Guzmán ◽  
E Martín Pérez ◽  
R. Montalti ◽  
...  
Keyword(s):  
Systematic Review ◽  
Liver Metastases ◽  
Thermal Ablation ◽  
Colorectal Liver Metastases ◽  
Ablation Techniques
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