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European Radiology

, Volume 28, Issue 7, pp 2727–2734 | Cite as

Ablation of colorectal liver metastasis: Interaction of ablation margins and RAS mutation profiling on local tumour progression-free survival

  • Marco Calandri
  • Suguru Yamashita
  • Carlo Gazzera
  • Paolo Fonio
  • Andrea Veltri
  • Sara Bustreo
  • Rahul A. Sheth
  • Steven M. Yevich
  • Jean-Nicolas Vauthey
  • Bruno C. OdisioEmail author
Interventional

Abstract

Objectives

To investigate effects of ablation margins on local tumour progression-free survival (LTPFS) according to RAS status in patients with colorectal liver metastases (CLM).

Methods

This two-institution retrospective study from 2005–2016 included 136 patients (91 male, median age 60 years) with 218 ablated CLM. LTPFS was performed using the Kaplan–Meier method and evaluated with the log-rank test. Uni/multivariate analyses were performed using Cox-regression models.

Results

Three-year LTPFS rates for CLM with minimal ablation margin ≤10 mm were significantly worse than those with >10 mm in both mutant-RAS (29% vs. 48%, p=0.038) and wild-type RAS (70% vs. 94%, p=0.039) subgroups. Three-year LTPFS rates of mutant-RAS were significantly worse than wild-type RAS in both CLM subgroups with minimal ablation margin ≤10 mm (29% vs. 70%, p<0.001) and >10 mm (48% vs. 94%, p=0.006). Predictors of worse LTPFS were ablation margins ≤10 mm (HR: 2.17, 95% CI 1.2–4.1, p=0.007), CLM size ≥2 cm (1.80, 1.1–2.8, p=0.017) and mutant-RAS (2.85, 1.7–4.6, p<0.001).

Conclusions

Minimal ablation margin and RAS status interact as independent predictors of LTPFS following CLM ablation. While minimal ablation margins >10 mm should be always the procedural goal, this becomes especially critical for mutant-RAS CLM.

Key Points

RAS and ablation margins are predictors of local tumour progression-free survival.

Ablation margin >10 mm, always desirable, is crucial for mutant RAS metastases.

Interventional radiologists should be aware of RAS status to optimize LTPFS.

Keywords

Colorectal neoplasms Metastasis DNA mutational analysis Interventional radiology Ablation techniques 

Abbreviations

CLM

Colorectal liver metastases

LTP

Local tumour progression

LTPFS

Local tumour progression-free survival

RAS

Rat sarcoma viral oncogene

Notes

Funding

This study has received funding by the National Institutes of Health/National Cancer Institute under award number P30CA016672

Compliance with ethical standards

Guarantor

The scientific guarantor of this publication is Bruno Odisio.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

Some study subjects have been partially previously reported in one paper: Odisio BC, Yamashita S, Huang SY, et al (2017) Br J Surg 104:760–768

Methodology

• retrospective

• observational

• multicentre study

Supplementary material

330_2017_5273_MOESM1_ESM.docx (28 kb)
ESM 1 (81 kb)
330_2017_5273_MOESM2_ESM.docx (25 kb)
ESM 1 (69 kb)

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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  • Marco Calandri
    • 1
  • Suguru Yamashita
    • 2
  • Carlo Gazzera
    • 1
  • Paolo Fonio
    • 1
  • Andrea Veltri
    • 3
  • Sara Bustreo
    • 4
  • Rahul A. Sheth
    • 5
  • Steven M. Yevich
    • 5
  • Jean-Nicolas Vauthey
    • 2
  • Bruno C. Odisio
    • 5
    Email author
  1. 1.Radiology Institute, Department of Surgical SciencesUniversity of TurinTorinoItaly
  2. 2.Department of Surgical OncologyThe University of Texas MD Anderson Cancer CenterHoustonUSA
  3. 3.Radiology Unit, Oncology Department, San Luigi Gonzaga HospitalUniversity of TurinOrbassanoItaly
  4. 4.Department of Medical Oncology 1Città della Salute e della ScienzaTorinoItaly
  5. 5.Department of Interventional RadiologyThe University of Texas MD Anderson Cancer CenterHoustonUSA

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