To evaluate whether treatment sequencing of image-guided thermal ablation (IGTA) relative to systemic therapy affects survival and local tumor control in patients with oligometastatic colorectal cancer with lung metastases.
Approach:
Study Design: A multicenter retrospective cohort study involving 289 patients who underwent CT-guided percutaneous thermal ablation between April 2015 and April 2023.
Patient Classification: Patients were classified into delayed-ablation, simultaneous-ablation, and instant-ablation groups based on the timing of ablation relative to systemic therapy.
Outcome Assessment: Overall survival (OS), progression-free survival (PFS), and local tumor progression-free survival (LTPFS) were assessed using Cox regression and inverse probability of treatment weighting (IPTW).
Key Findings:
Simultaneous ablation was associated with a lower risk of death compared to delayed ablation (HR, 0.51; 95% CI, 0.27-0.96; P = 0.037).
Instant ablation did not show an overall survival advantage.
Simultaneous ablation showed a trend toward improved PFS (HR, 0.75; 95% CI, 0.55-1.03; P = 0.076).
Instant ablation was associated with a higher risk of local tumor progression (HR, 2.62; 95% CI, 1.28-5.37; P = 0.008).
The primary technical success rate was 97.5%, and secondary technical success reached 100%.
Interpretation:
Limitations:
Retrospective design may introduce selection bias.
Lack of prospective validation of findings.
Conclusion:
Simultaneous ablation is associated with longer overall survival, while instant ablation may compromise local control.
