Thermal ablation versus hepatectomy in patients with liver metastases from RAS-mutated colorectal cancer

OBJECTIVE: To compare the efficacy and safety of thermal ablation therapy and hepatectomy in patients with RAS-mutated colorectal liver metastases (CRLMs). MATERIALS AND METHODS: A 1:1 propensity score matching (PSM) analysis was conducted to categorize patients into thermal ablation and hepatectomy groups with comparable propensity scores. Progression-free survival (PFS) was determined by the Kaplan-Meier method. A Cox regression model was used to examine the prognostic factors. RESULTS: Following PSM analysis, 38 pairs of patients were enrolled into two groups. Before PSM, the median PFS in the thermal ablation group was longer compared with that in the hepatectomy group (14.0 vs. 10.0 months, P = 0.075). A statistically significant difference was observed following PSM, with the median PFS of patients in the thermal ablation group being significantly longer compared with that in the hepatectomy group (13.0 vs. 9.0 months, P = 0.021). The results of the multifactorial analysis of the Cox regression demonstrated that the treatment modality (thermal ablation/hepatectomy) was an independent prognostic factor that affects PFS ( P < 0.05). The postoperative recurrence rates of the two groups were not significantly different before and after PSM. Regarding treatment safety, complications were significantly more prevalent in the hepatectomy group compared with that in the ablation treatment group before PSM ( P = 0.003), whereas no significant difference in complications was observed between the two groups following PSM ( P = 0.169). CONCLUSION: Thermal tumor ablation is a favorable treatment option for patients with RAS-mutated CRLM, particularly for those with tumors of specific size ranges (≤5 cm) and an appropriate tumor burden.