A prospective multi-centre trial on survival after Microwave Ablation VErsus Resection for Resectable Colorectal liver metastases (MAVERRIC)
Menée auprès de 158 témoins et 98 patients présentant des petites métastases hépatiques ayant pour origine un cancer colorectal, cette étude multicentrique évalue la non-infériorité, du point de vue de la survie globale à 3 ans, d'une ablation stéréotaxique percutanée par rapport à une résection hépatique
Résumé en anglais
Aim: This multi-centre prospective cohort study aimed to investigate non-inferiority in patients’ overall survival when treating potentially resectable CRLM with stereotactic microwave ablation (SMWA) as opposed to hepatic resection (HR).
Methods: Patients with no more than 5 CRLM no larger 30mm, deemed eligible for both SMWA and hepatic resection at the local multi-disciplinary team meetings, were deliberately treated with SMWA (study group). The contemporary control group consisted of patients with no more than 5 CRLM, none larger than 30mm, treated with HR, extracted from a prospectively maintained nationwide Swedish database. After propensity-score matching, three-year overall survival (OS) was compared as the primary outcome using Kaplan-Meier and Cox regression analyses.
Results: All patients in the study group (n=98) were matched to 158 patients from the control group (mean standardized difference in baseline covariates = 0.077). OS rates at 3 years were 78% (Confidence interval 68 - 85%) after SMWA versus 76% (CI 69 - 82%) after HR (stratified Log rank test p=0.861). Estimated 5-year OS rates were 56% (CI 45 - 66%) versus 58% (CI 50 - 66%). The adjusted hazard ratio for treatment type was 1.020 (CI 0.689 - 1.510). Overall and major complications were lower after SMWA (percentage decrease 67% and 80%, p<0.01). Hepatic retreatments were more frequent after SMWA (percentage increase 78%, p<0.01).
Conclusion: SMWA is a valid curative-intent treatment alternative to surgical resection for small resectable CRLM. It represents an attractive option in terms of treatment-related morbidity with potentially wider options regarding hepatic re-treatments over the future course of disease.
