井上 政則

ABSTRACT Background Surgical resection is the standard treatment for pulmonary metastases from colorectal cancer, but its safety and long‐term efficacy in medically inoperable patients remain limited. Percutaneous cryoablation is a minimally invasive alternative to surgical resection and has gained increasing attention in recent years. Aims This retrospective study aimed to evaluate complication rates, local tumor control, and overall survival associated with percutaneous cryoablation for pulmonary metastases from colorectal cancer. Methods and Results We retrospectively reviewed patients treated with percutaneous cryoablation from 2002–2017. Complications were defined as adverse events ≥ grade 2 per Common Terminology Criteria for Adverse Events version 5.0. In total, 126 metastatic pulmonary tumors in 48 patients were treated across 73 sessions. Complications occurred in 18 sessions (24.7%), including 2 grade ≥ 3 events (2.7%). No treatment‐related deaths occurred within 30 days. With a median follow‐up of 9.7 months (maximum, 155.4 months), local tumor control rates at 1, 3, and 5 years were 74.5%, 58.8%, and 56.4%, respectively. Median overall survival was 3.8 years, with 1‐, 3‐, 5‐, and 10‐years rates of 86.8%, 60.4%, 41.9%, and 36.6%, respectively. The relatively short median follow‐up should be considered when interpreting these long‐term local control estimates. Six patients achieved 10‐years survival. Conclusion Percutaneous cryoablation is a safe, minimally invasive option that provides favorable local tumor control and encouraging long‐term survival outcomes.

Abstract Development of subclassification of intermediate-stage hepatocellular carcinoma (HCC) by treatment suitability is in demand. We aimed to identify predictors that define treatment refractoriness against locoregional(transarterial chemoembolization(TACE) or thermal ablation) and surgical therapy. This multicenter retrospective study enrolled 1167 HCC patients between 2015 and 2021. Of those, 209 patients were initially diagnosed with intermediate-stage HCC. Treatment refractoriness was defined as clinical settings that meets the following untreatable progressive conditions by TACE (1) 25% increase of intrahepatic tumor, (2) transient deterioration to Child–Pugh class C, (3) macrovascular invasion or extrahepatic spread, within one year. We then analyzed factors contributing to treatment refractoriness. The Child–Pugh score/class, number of tumors, infiltrative radiological type, and recurrence were significant factors. Focusing on recurrence as a predictor, median time to untreatable progression (TTUP) was 17.2 months in the recurrence subgroup whereas 35.5 months in the initial occurrence subgroup (HR, 2.06; 95% CI, 1.44–2.96; P = 0.001). Median TTUP decreased in cases with more later times of recurrence (3–5 recurrences, 17.3 months; ≥ 6 recurrences, 7.7 months). Recurrence, even more at later times, leads to increased treatment refractoriness. Early introduction of multidisciplinary treatment should be considered against HCC patients after multiple recurrent episodes.