Background: Colorectal cancer (CRC) is the second most common cause of cancer-related deaths in the US. Thermal ablation (TA) can be a comparable alternative to partial hepatectomy for selected cases when eradication of all visible tumor with an ablative margin of greater than 5 mm is achieved. This systematic review and meta-analysis aimed to encapsulate the current clinical evidence concerning the optimal TA margin for local cure in patients with colorectal liver metastases (CLM). Methods: MEDLINE, EMBASE, and the CENTRAL databases were systematically searched from inception until 1 May 2023, in accordance with the PRISMA Guidelines. Measure of effect included the risk ratio (RR) with 95% confidence interval (CI) using the random-effects model. Results: Overall, 21 studies were included, comprising 2005 participants and 2873 ablated CLMs. TA with margins less than 5 mm were associated with a 3.6 times higher risk for LTP (n = 21 studies, RR: 3.60; 95% CI: 2.58–5.03;p-value < 0.001). When margins less than 5 mm were additionally confirmed by using 3D software, a 5.1 times higher risk for LTP (n = 4 studies, RR: 5.10; 95% CI: 1.45–17.90;p-value < 0.001) was recorded. Moreover, a thermal ablation margin of less than 10 mm but over 5 mm remained significantly associated with 3.64 times higher risk for LTP vs. minimal margin larger than 10 mm (n = 7 studies, RR: 3.64; 95% CI: 1.31–10.10;p-value < 0.001). Conclusions: This meta-analysis solidifies that a minimal ablation margin over 5 mm is the minimum critical endpoint required, whereas a minimal margin of at least 10 mm yields optimal local tumor control after TA of CLMs.
背景：结直肠癌是美国癌症相关死亡的第二大常见原因。对于部分病例，若能通过热消融实现所有可见肿瘤的完全清除且消融边缘大于5毫米，则可作为部分肝切除术的有效替代方案。本系统综述与荟萃分析旨在整合当前关于结直肠癌肝转移患者局部根治最佳热消融边缘的临床证据。 方法：根据PRISMA指南，系统检索了MEDLINE、EMBASE和CENTRAL数据库自建库至2023年5月1日的文献。采用随机效应模型计算风险比及其95%置信区间作为效应量指标。 结果：共纳入21项研究，涵盖2005名参与者及2873个消融的结直肠癌肝转移灶。消融边缘小于5毫米时局部肿瘤进展风险增加3.6倍（纳入21项研究，RR：3.60；95% CI：2.58–5.03；p值<0.001）。当使用三维软件进一步确认边缘小于5毫米时，局部肿瘤进展风险增至5.1倍（纳入4项研究，RR：5.10；95% CI：1.45–17.90；p值<0.001）。此外，与大于10毫米的最小边缘相比，5-10毫米的热消融边缘仍使局部肿瘤进展风险显著增加3.64倍（纳入7项研究，RR：3.64；95% CI：1.31–10.10；p值<0.001）。 结论：本荟萃分析证实，超过5毫米的最小消融边缘是必需达到的关键阈值，而至少10毫米的最小消融边缘能为结直肠癌肝转移热消融术后提供最优的局部肿瘤控制效果。
肿瘤(癌症)患者之家