旨在在多中心队列和两个确认软件中评估 CT 引导结直肠肝转移热消融 (CRLM) 后最小消融切缘 (MAM) 与局部肿瘤进展 (LTP) 之间的关联。这项多中心回顾性研究包括接受 CT 治疗的患者- 2009 年至 2021 年间，三个机构对 CRLM 进行引导射频或微波消融术。使用专用消融确认软件，通过自动非刚性（消融贴合）或半自动刚性联合配准（SAFIR）对术中消融前和消融后对比增强 CT 扫描对三维 (3D) MAM 进行回顾性评估两个独立的读者团队对患者的治疗结果不知情。 LTP 以每个肿瘤为基础进行评估。使用多变量 Cox 回归分析评估与无 LTP 生存相关的因素。总体而言，113 名接受热消融治疗 189 CRLM（平均直径：1.9±1.1cm）的患者（平均年龄：67±10 岁；78 名男性）符合纳入标准标准。使用这两种软件都可以成功分析 173/189 (92%) CRLM。在中位随访 31 个月（IQR：22-47）中，173 名 CRLM 中有 21 名（12.1%）发展为 LTP。在多变量分析中，3D MAM 在两个软件中均与 LTP 独立相关（消融拟合：HR 0.47，95% CI：0.36-0.61，p < 0.001；SAFIR：HR 0.42，95% CI：0.32-0.55，p < 0.001 ）。在用MAM ≥ 4 mm（Ablation-fit）和≥ 5 mm（SAFIR）消融的CRLM中未观察到LTP。两个软件之间 MAM 定量的每个肿瘤中值绝对差异为 2mm（IQR：1-3）。跨多中心数据和两个确认软件，在 CRLM 热消融后，MAM 与 LTP 独立相关。在两个软件中，达到 MAM ≥ 5 mm 的消融均与局部控制相关。在多中心数据和两个确认软件中，来自术中对比增强 CT 的 MAM 与 CRLM 热消融后的 LTP 独立相关，边缘≥ 5 mm 与局部控制相关。足够的烧蚀余量对于 CRLM 热烧蚀后的局部控制至关重要。术中 CT 衍生的 MAM 是两个确认软件中与 LTP 相关的唯一独立因素。在 MAM ≥ 5 mm 消融的 CRLM 中未观察到 LTP。© 2024。作者。

To assess the association between minimal ablative margin (MAM) and local tumor progression (LTP) following CT-guided thermal ablation of colorectal liver metastases (CRLM) in a multicenter cohort and across two confirmation software.This multicenter retrospective study included patients who underwent CT-guided radiofrequency or microwave ablation for CRLM between 2009 and 2021 in three institutions. Three-dimensional (3D) MAM was retrospectively assessed using dedicated ablation confirmation software by automatic non-rigid (Ablation-fit) or semi-automatic rigid co-registration (SAFIR) of intraprocedural pre- and post-ablation contrast-enhanced CT scans by two independent reader teams blinded to patient outcomes. LTP was assessed on a per-tumor basis. Factors associated with LTP-free survival were assessed using multivariable Cox regression analysis.Overall, 113 patients (mean age: 67 ± 10 years; 78 men) who underwent thermal ablation for 189 CRLM (mean diameter: 1.9 ± 1.1 cm) met the inclusion criteria. 173/189 (92%) CRLM could be successfully analyzed using both software. Over a median follow-up of 31 months (IQR: 22-47), 21 of 173 CRLM (12.1%) developed LTP. On multivariable analysis, 3D MAM was independently associated with LTP in both software (Ablation-fit: HR 0.47, 95% CI: 0.36-0.61, p < 0.001; SAFIR: HR 0.42, 95% CI: 0.32-0.55, p < 0.001). No LTP was observed in CRLM ablated with MAM ≥ 4 mm (Ablation-fit) and ≥ 5 mm (SAFIR). The per-tumor median absolute difference in MAM quantification between both software was 2 mm (IQR: 1-3).MAM was independently associated with LTP after thermal ablation of CRLM across multicenter data and two confirmation software. Ablations achieving a MAM ≥ 5 mm were associated with local control in both software.MAMs from intraprocedural contrast-enhanced CT were independently associated with LTP after thermal ablation of CRLM across multicenter data and two confirmation software, with a margin ≥ 5 mm associated with local control in both software.Sufficient ablative margins are critical for local control following thermal ablation of CRLM. Intraprocedural CT-derived MAM was the only independent factor associated with LTP across two confirmation software. No LTP was observed in CRLM ablated with a MAM ≥ 5 mm.© 2024. The Author(s).