Microwave ablation versus resection for colorectal cancer liver metastases - A propensity score analysis from a population-based nationwide registry.

Tinguely, Pascale; Dal, Gabriella; Bottai, Matteo; Nilsson, Henrik; Freedman, Jacob; Engstrand, Jennie (2020). Microwave ablation versus resection for colorectal cancer liver metastases - A propensity score analysis from a population-based nationwide registry. European journal of surgical oncology EJSO, 46(3), pp. 476-485. Elsevier 10.1016/j.ejso.2019.12.002

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INTRODUCTION

Many previous studies comparing liver resection versus thermal ablation for colorectal cancer liver metastases (CRCLM) are subject to severe selection bias. The aim of this study was to compare survival after microwave ablation (MWA) versus liver resection for CRCLM in a population-based cohort study using propensity score analysis to reduce confounding by indication.

METHODS

All patients undergoing liver resection or MWA as a first intervention for CRCLM measuring ≤ 3 cm between 2013 and 2016 in Sweden were included from a nationwide registry. Treatment effect was estimated after propensity score matching, adjusting for patient and tumour factors known to affect the choice of treatment approach. Descriptive, regression and survival statistics were applied.

RESULTS

The unmatched cohorts (82 MWA patients, 645 resection patients) differed significantly regarding age, American Society of Anaesthesiologists class, Charlson comorbidity index, primary tumour location, number of metastases and previous chemotherapy, with 3-year overall survival (OS) favouring resection over MWA (76 and 69%, p = 0.005). After propensity score matching (70 MWA patients, 201 resection patients), no difference in 3-year OS was shown between resected and ablated patients (76% and 76%, p = 0.253), with a median OS of 54.7 (95% confidence interval 48.6 - 60.9) months and 48 (40.1-56.1) months, respectively.

CONCLUSION

After adjusting for factors known to affect treatment choice, no significant difference in OS was shown after MWA versus resection for CRCLM. This supports the potential role of MWA as a valid first-line treatment for patients with small CRCLM.

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