Radiofrequency ablation versus partial hepatectomy with or without radiofrequency ablation for colorectal cancer liver metastases

Radiofrequency ablation versus partial hepatectomy with or without radiofrequency ablation for colorectal cancer liver metastases | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Radiofrequency ablation versus partial hepatectomy with or without radiofrequency ablation for colorectal cancer liver metastases HaoNan Liu, Yuhan Zhou, TianLi Liu, Yujing Zhang, Yitao Liu, Xiaoyu Li, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7703592/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Colorectal cancer (CRC) is a common malignancy. 20–40% of bowel cancers are accompanied by liver metastases, and liver failure due to liver metastases is the most common cause of death in bowel cancer patients. Radiofrequency ablation (RFA) and partial hepatectomy (PH) are two commonly used treatments for colorectal cancer liver metastases. The aim of this paper is to compare the relapse -free survival (RFS) and overall survival (OS) of intrahepatic lesions between these two treatment modalities. Methods We retrospectively analysed the data of patients who underwent surgery for CRLM at the First Affiliated Hospital of Xi'an Jiaotong University from 2017 to 2024 and were diagnosed with CRLM by postoperative pathology. We collected the clinicopathological characteristics of the patients in the RFA group and the patients in the PH group with or without RFA, and compared the RFS and OS of intrahepatic foci of these two treatment modalities using the log - rank test. The patients were also scored by CRS, and the differences in postoperative RFS and OS between patients with high CRS scores (≥ 3) and those with low CRS scores (< 3) were compared using the log - rank test. Finally, univariate analysis and multifactorial Cox regression survival analysis were performed to identify independent risk factors affecting prognosis. Results A total of 109 CRLM patients were included, 50 of whom underwent RFA and 59 underwent PH. The RFS of the RFA Group (median RFS: 14 months) was significantly shorter than that of the PH group (median RFS: 23 months) (P = 0.013). While there was no significant difference in OS between the two groups (RFA Group median OS: undefined, PH group median OS: 62 months) (P = 0.109). The RFS of the CRS high - scoring group (median RFS: 13 months) was slightly shorter than that of the CRS low - score group (median RFS: 17 months) (P = 0.349), and there was no significant difference. The median OS of the CRS high - score group vs the CRS low - score group was undefined (P: 0.711), and there was no significant difference between the two groups. For RFS, the independent factors were surgical method and CEA. For OS, there were no independent factors. Conclusions The RFS and the OS of the PH group vs the RFA Group suggested that the patients with PH with or without RFA for CRLM may have better short - term control than the RFA group. The RFS and the OS of the CRS high - score group vs the CRS low - score group suggested that the CRS score might not accurately predict the RFS and the OS of CRLM patients after PH or RFA. radiofrequency ablation partial hepatectomy colorectal cancer liver metastases prognosis CRS Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Figure 9 Figure 10 Figure 11 Figure 12 Highlight box Key findings Survival comparison: The PH group had a significantly longer median RFS (23 months) than the RFA group (14 months). However, there was no significant difference in OS between the two groups.CRS score: CRS score didn't significantly affect RFS or OS, suggesting it may not be a reliable factor for surgical decisions.Complications and costs: RFA had fewer postoperative complications, shorter hospital stays, and lower costs compared to PH. What is known and what is new? PH benefits CRLM patients, and RFA is a minimally - invasive option. RFA has a higher recurrence rate but fewer complications. This study offers more evidence on RFS and OS differences between RFA and PH. It also challenges the use of the CRS score in modern treatment. What is the implication, and what should change now? Implications: Clinicians should balance short - term tumor control and complications. RFA is a good option for patients who can't tolerate invasive surgery.Actions needed: Conduct large - scale multicenter RCTs. Develop comprehensive predictive models for better treatment decisions. 1. Introduction Colorectal cancer (CRC) is one of the malignancies with the highest incidence. Additionally, CRC patients may develop liver metastasis, which is the major cause of death( 1 , 2 ).Approximately 15 to 25 percent of colorectal cancer patients present with liver metastasis at the time of diagnosis, and approximately 50 percent of patients will develop liver metastasis during the course of their disease( 3 , 4 ).Colorectal liver metastases (CRLM) may be associated with several factors, including the direct connection between the colorectal region and the liver via the portal vein system, which is characterized by abundant blood flow, as well as the location and histological type of the primary tumor( 5 ).Curative resection and systemic chemotherapy remain the standard treatment methods for patients with CRLM. Among them, 10–20% CRLM patients are considered resectable, and 30–40% are initially unresectable, but their tumours can shrink through transformative chemotherapy( 6 ).For initially unresectable patients, after successful conversion and subsequent resection of liver metastases, the survival time of patients with CRLM can still be significantly prolonged( 7 ). Partial hepatectomy has been considered one of the most effective treatments for colorectal cancer liver metastases, with 20% − 30% of patients deriving long - term overall survival benefit from resection of liver metastases( 8 , 9 ). Radiofrequency ablation (RFA) is a thermal ablation technique that induces coagulative necrsis in the targeted liver tumor with the advantage of better preserved liver function( 10 ).For CRLM patients with multiple intrahepatic metastases, a treatment strategy combining liver resection with radiofrequency ablation may be considered. Alternatively, radiofrequency ablation as a standalone intervention can also be employed for lesion management( 11 , 12 ). The Clinical Risk Score (CRS score), including five clinical factors: nodal status of primary, disease-free interval from the primary to discovery of the liver metastases of 1, preoperative CEA level > 200 ng/ml, and size of the largest tumor > 5 cm, has been well accepted for long-term outcome prediction after hepatic resection for CRLM patients( 13 , 14 ). This study endeavored to investigate the disparities between partial hepatectomy with or without radiofrequency ablation and radiofrequency ablation alone in the treatment of CRLM, and whether low CRS score (< 3) was significantly associated with better survival after artial hepatectomy with or without radiofrequency ablation and radiofrequency ablation alone via a retrospective controlled study. We present this article in accordance with the STORBE reporting checklist. 2. Methods 2.1 Study design and patient selection As shown in Fig. 1 .We retrospectively collected and analyzed the clinical data and follow-up information of patients with colorectal cancer liver metastasis who were diagnosed and treated at the First Affiliated Hospital of Xi'an Jiaotong University from 2017 to 2024. The inclusion criteria for the patients enrolled in this study are as follows: 1. Age 18–85 years old; 2. Complied with the diagnostic criteria for CRLM; 3. Received liver resection and/or radiofrequency ablation for CRLM; 4. Child-Pugh grade A or B liver function status; 5. No previous systemic or surgical treatment for primary liver cancer. Exclusion Criteria: 1. Radical therapeutic modalities was no longer considered safe or feasible; 2. The number of liver metastases from colorectal cancer exceeds 10; 3. the existence of extrahepatic metastatic lesions; 4. Inability to extract sufficient clinical or follow-up data; 5. Presence of autoimmune disease( 15 ). All the enrolled patients were categorized into the radiofrequency ablation group (RFA group) and the partial hepatectomy combined with or without radiofrequency ablation group (PH group). CRLM cases which only underwent RFA treatment were classified as the radiofrequency ablation group, while those receiving partial hepatectomy combined with or without RFA were PH group. We collected the clinicopathological characteristics of patients from both groups: Age, Gender, therapeutic modalities, CEA, tumor in a single liver lobe or in both lobes of the liver, history of preoperative chemotherapy, status of lymph node metastasis, serum CA199, maximum diameter of hepatic lesion, ALBI liver function classification. The Fong Clinical Risk Score (CRS) for Colorectal Cancer Recurrence, which included five clinical criteria: nodal status of primary, disease-free interval from the primary to discovery of the liver metastases of 1, preoperative CEA level > 200 ng/ml, and size of the largest tumor > 5 cm, also carried out and each criteria was assigned one point, and the sum of each score constituted the total score. All patients were divided into two group: less than 3 points as low CRS score group and 3–5 points as high CRS score group( 16 ). 2.2 Surgical therapeutic modalitiess Radiofrequency ablation: The RFA treatments incorporated in this study consisted of both percutaneous RFA and laparoscopic RFA for liver tumor lesions. Radiofrequency electrodes were inserted into the tumour tissue under the guidance of ultrasound. The generator was connected to start the ablation therapeutic modalities. Upon the conclusion of the radiofrequency ablation treatment, the radiofrequency electrode was withdrawn, and local compression bandaging was implemented at the puncture point for hemostasis. The liver metastatic tumor lesion treated in the RFA group did not entirely comply with the criteria for radiofrequency ablation as listed in Table 1 . Table 1 Ablatability criteria in this study. Ablatability criteria 1. maximum CRLM size ≤ 3 cm 2. a tumor free margin of > 10 mm after RFA 3. a minimum distance (lesion to major bile duct) of 15 mm is required to preserve the major bile ducts (common bile duct and main branches of the bile duct) 4. maximum total number of CRLM 10 Partial hepatectomy: Partial hepatectomy encompassed laparoscopic partial hepatectomy and open partial hepatectomy. During PH, the surgeon excised all the lesions that were not amenable to RFA (ablatability criteria was shown in Table 1 ) and those located on the liver surface. Intraoperative ultrasound was employed to search for and localize the liver metastatic tumor foci. All surgical margins were required to achieve R0 resection, but there was no demand for a considerable distance between the margin and the tumor boundary. 2.3 Follow - up information All patients were underwent routine follow-up examinations including imaging and laboratory tests every 3 months for the first year and every 6 months postoperatively. Follow-up cross-sectional imaging included at least an abdominal enhanced CT or Gd-EOB-DTPA MRI at the given time-points. Quality of life questionnaires were assessed at baseline, every 3 months for the first year and every 6 months 2.4 Primary and secondary objectives The main objective in this study was to figure out which treatment modality, RFA alone or partial hepatectomy with or without RFA, can prolong the recurrence-free survival time of intrahepatic tumors or overall survival for resectable or radiofrequency ablation (RFA)-treatable CRLM patients. The secondary points were whether patients with CRLM having a CRS score higher than 3 were truly ineligible for resection of liver metastases or radiofrequency ablation treatment. The other factors including procedural morbidity and mortality and cost-effectiveness ratio (ICER) were also determined in this study. Relapse -free survival (RFS) was defined as the time from liver surgery to recurrence of the tumour lesion or death from any cause. Overall survival (OS) was defined as the time from liver surgery to death from any cause. 2.5 Statistical analyses It is expected that 10 variables will be considered, and based on a 10-20-fold relationship, it is expected that a sample size of approximately 100 will be required .All clinicopathological and procedural variables were comprehensively described and analyzed. Continuous variables were summarized using standard statistical methods, including means, standard deviations, medians, and ranges. Categorical variables will be presented as frequencies and proportions. Univariate survival analysis was carried out using the Kaplan-Meier survival curves. Differences in survival durations were evaluated using the log-rank test. For multivariate analysis, Cox proportional hazards regression was employed to estimate hazard ratios (HR). The significance of differences for continuous and categorical data was assessed using the Mann-Whitney U test and the Chi-square test, respectively. P-values below 0.05 will be considered significant. All statistical analyses were performed using SPSS Statistics version 25 (IBM Corporation, Armonk, New York, USA), GraphPad Prism version 10 and RStudio version 4.4.3. The 95 95% CI confidence intervals for the risk ratios (HR) were estimated using the Cox proportional risk model, and the effects of clinical prognostic variables on RFS and OS were assessed by univariate and multivariate Cox regression analyses using either the log - rank test or the weighted Wilcoxon test, depending on the type of information. 3. Results 3.1 Study population From November 2017 to September 2024, a total of 409 cases of patients with liver metastases were admitted to the Department of Hepatobiliary Surgery and the Department of General Surgery of the First Affiliated Hospital of Xi'an Jiaotong University. A total of 190 patients with CRLM were excluded due to failure to meet the criteria for radical resection or radiofrequency ablation of liver metastases. 39 patients were excluded from the study because of the absence of standard follow-up data, and Thirty-five patients were lost to follow-up during the early postoperative phase. 31 patients, despite meeting the criteria for radical resection of liver metastases or radiofrequency ablation, did not undergo the corresponding treatments but only received systemic chemotherapy. 7 patients were excluded on account of receiving selective internal radiotherapy with yttrium-90. Finally, there were a total of 109 patients with CRLM incorporated into this retrospective cohort control study. Among them, 50 patients with CRLM solely underwent radical RFA therapy and constituted the RFA group. 59 patients with CRLM received partial liver resection combined with or without radiofrequency ablation therapy and formed the PH group.The detailed baseline characteristics of all 109 CRLM patients are summarized in Table 2 . There were no significant differences in the demography, tumor characteristics and laboratory test results between the two groups of CRLM patients.. In accordance with the CRS scoring standards, 39 cases of CRLM were categorized into the high CRS score group, whereas 73 cases of CRLM were in the low CRS score group. Table 2 Characteristics of CRLM patients stratified by therapeutic modalitiess group n(%).RFA: Radiofrequency ablation; CEA: Carcinoembryonic antigen.CA19–9: A carbohydrate antigen and also a tumor marker, used in the analysis of the patient's condition in the article, but its relationship with RFS and OS is not significant.ALBI: Abbreviation for Albumin - bilirubin, used in the article to evaluate the patient's liver function status.All variables were dichotomised and continuous variables were dichotomised by median. Factors RFA Group PH Group p Age at diagnosis ≤ 60years 29 (58.0) 29 (49.2) 0.465 >60years 21 (42.0) 30 (50.8) Gender Male 34 (68.0) 38 (64.4) 0.848 Female 16 (32.0) 21 (35.6) CEA ≤ 5.81ng/ml 27 (54.0) 28 (47.5) 0.625 >5.81ng/ml 23 (46.0) 31 (52.5) Whether bilobar involvement No 34 (68.0) 44 (74.6) 0.586 Yes 16 (32.0) 15 (25.4) Number of lines of first-line chemotherapy ≤ 1 35 (70.0) 41 (69.5) 1.000 >1 15 (30.0) 18 (30.5) Duration/cycle of first-line chemotherapy ≤ 7cycle 27 (54.0) 28 (47.5) 0.625 >7cycle 23 (46.0) 31 (52.5) Whether lymph node metastases No 36 (72.0) 42 (71.2) 1.000 Yes 14 (28.0) 17 (28.8) CA19−9 ≤ 20U/ml 30 (60.0) 25 (43.1) 0.119 >20U/ml 20 (40.0) 33 (56.9) Maximum diameter of the hepatic lesion ≤ 2.2cm 32 (64.0) 23 (39.0) 0.016 >2.2cm 18 (36.0) 36 (61.0) ALBI classification ≤−15.06g/L 25 (50.0) 30 (50.8) 1.000 >−15.06g/L 25 (50.0) 29 (49.2) 3.2 Intrahepatic tumour RFS As shown in Fig. 2 ,the RFS of intrahepatic lesions in the PH group (median RFS: 23 months) was significantly superior to that in the RFA group (median RFS: 14 months) (P = 0.013, HR = 0.509, 95% CI: 0.299–0.864). It supported that in contrast to RFA therapy, PH for CRLM patients had a lower postoperative recurrence. To explore whether patients with CRLM having a CRS score higher than or equal to 3 had the unfavorable RFS after radiofrequency ablation or partial hepatectomy of liver metastase lesions, we compared the RFS of patients with a CRS score greater than or equal to 3 and those with a score less than 3 in this study. It was found that the RFS of CRLM patients with a high CRS (median RFS: 13 months) was not poor (P = 0.349, HR: 1.308, 95% CI: 0.769–2.223; Fig. 3 ), compared to those from low CRS score group (median RFS: 17 months),which suggested that the CRS score might not accurately predict the RFS of CRLM patients after partial hepatectomy or radiofrequency ablation. Subsequently, we carried out a univariate analysis regarding the non-recurrence of intrahepatic tumors in CRLM. As presented in Fig. 4 and Fig. 5 A- 5 J, it was found that compared with other demographic characteristics and clinical factors, only partial hepatectomy significantly affected the RFS of intrahepatic tumors for CRLM. Five prognostic factors with a certain degree of statistical significance (P 60 years), Whether bilobar involvement (No vs Yes), Number of lines of first - line chemotherapy (≤ 1 vs > 1), CEA (≤ 5.81 ng/ml vs > 5.81 ng/ml). As presented in Fig. 6 ,COX multivariate analysis revealed that the treatment modality (P = 0.021, HR = 1.859, 95% CI: 1.098–3.146) and the serum CEA level (P = 0.041, HR = 0.605, 95% CI: 0.358–1.024) were independent influencing factors for the post-surgical RFS of intrahepatic tumors for CRLM. 3.3 Overall survival As shown in Fig. 7 ,the OS of intrahepatic lesions in the RFA Group (median OS: undefined)VS the PH group (median OS: 62 months) (P = 0.306, HR = 0.406, 95% CI: 0.141–1.174). It supported that there was no significant difference in OS between the RFA group and the PH group. To explore whether patients with CRLM having a CRS score higher than or equal to 3 had the unfavorable OS after radiofrequency ablation or partial hepatectomy of liver metastase lesions, we compared the OS of patients with a CRS score greater than or equal to 3 and those with a score less than 3 in this study. It was found that the OS of CRLM patients with a high CRS was not poor (P: 0.711, HR: 0.636, 95% Cl: 0.190 to 2.124; Fig. 8 ), compared to those from low CRS score group. which suggested that the CRS score might not accurately predict the OS of CRLM patients after partial hepatectomy or radiofrequency ablation.Medain OS of both groups were undefined, because the mortality of patients in both groups did not exceed half. Subsequently, we carried out a univariate analysis regarding the OS in CRLM patients. As presented in Fig. 9 and Fig. 10 A- 10 J, it was found that compared with other demographic characteristics and clinical factors, only partial hepatectomy significantly affected the OS of CRLM patients. Five prognostic factors with a certain degree of statistical significance (P < 0.20) were selected from the outcome of the univariate analysis for COX multivariate regression analysis, including Therapeutic modalities (RFA Group vs PH group), Gender (Male vs Female), Whether bilobar involvement (No vs Yes), CA19–9 (≤ 20 U/ml vs > 20 U/ml), and CEA (≤ 5.81 ng/ml vs > 5.81 ng/ml). As presented in Fig. 11 ,COX multivariate analysis revealed that no independent prognostic factor for OS of CRLM patients. 3.4 Safety assessment and cost - effectiveness There were no treatment-related deaths among the patients enrolled in this study..As shown in Table 3 , there were 4 cases of intra-abdominal infection (8%), and 1 case of bile leakage (2%) in the RFA group. No adverse reactions such as pleural effusion and liver failure occurred. In the PH group, 9 cases (15%) of abdominal infection, 5 cases (8%) of liver failure, 3 cases (5%) of bile leakage, and 12 cases (20%) of pleural effusion occurred. Table 3 Adverse reaction after surgical treatment for colorectal liver metastasis n(%).RFA: Radiofrequency ablation;PH:Partial hepatectomy TRAE RFA Group PH Group Infection 4( 8 ) 9( 15 ) Liver failure 0(0) 5( 8 ) Bile fistula 1( 2 ) 3( 5 ) Pleural effusion 0(0) 12( 20 ) The median length of hospital stay for patients in the RFA group was 5 days (ranging from 3 days to 7 days). The hospitalization expenses of patients in the RFA group varied considerably, ranging from ¥ 20,000 to ¥ 60,000, with an average expense of ¥ 40,000. The duration of hospital stay for patients in the PH group (median length of hospital stay: 11 days) was significantly prolonged compared with the RFA group (Fig. 12 A).The hospitalization costs of the PH group were significantly greater than those of the RFA group (Fig. 12 B). 4. Discussion It is currently widely acknowledged that surgical resection for locally resectable liver metastases from colorectal cancer can evidently prolong the survival time of patients with 40%-50% of 5-year post-surgical survival rate(17,18). Radiofrequency ablation is also a minimally invasive local therapeutic modality that is extensively applied in the treatment of various liver metastases. The CLOCC study demonstrates that radiofrequency ablation in combination with chemotherapy for unresectable liver metastases yields better therapeutic outcomes for CRLM than chemotherapy alone(19). Regarding resectable liver metastases, there is a controversy as to whether partial hepatectomy or radiofrequency ablation is superior. A multitude of studies demonstrated that the recurrence rate of intrahepatic tumors and the overall tumor recurrence rate subsequent to RFA treatment were higher in contrast to those after partial hepatectomy( 20 – 22 ). Nevertheless, RFA treatment exhibits a lower incidence of postoperative complications and lower hospitalization expenses. Some research has put forward that the overall survival time of patients with ≤ 3cm CRLM treated with RFA and partial hepatectomy was comparable( 23 , 24 ), yet other studies have indicated that the overall survival time of patients with colorectal cancer liver metastases treated with partial hepatectomy was superior to that of those treated with RFA( 25 ). And for patients with multiple CRLM, combined ablation and partial hepatectomy were found to be a superior treatment strategy compared to hepatectomy alone, as it avoided major hepatectomy, achieved better surgical outcomes, and provided comparable oncologic results( 26 ). This study intended to explore, through a retrospective cohort study, which approach was superior for the treatment of CRLM: RFA or PH combined with or without RFA.and also to evaluate the prognostic impact of the clinicopathological factors and CRS score. The median time to recurrence-free of intrahepatic lesions in the PH group (23 months) was higher than that in the RFA group (14 months). And analysis of Kaplan-Meier survival curves also supported that partial hepatectomy had a significant advantage in controlling intrahepatic tumor progression. Cox multivariate analysis showed that the therapeutic modalities and serum CEA level were independent risk factors affecting intrahepatic tumor PFS. Some RFA procedures may fail to completely ablate the tumor, while hepatectomy can guarantee R0 resection of the tumor. This might be the cause for the longer recurrence-free survival time of intrahepatic tumors in the hepatectomy group compared to that in the RFA group. Consistent with the findings of multiple previous studies( 27 ), this study also discovered that a relatively high preoperative plasma CEA level was an unfavorable prognostic factor after colorectal cancer surgery. This might be attributed to the correlation between CEA and poorer tumor differentiation or staging. Although the PFS of intrahepatic lesions in the PH group was superior to that in the RFA group, upon analyzing the Kaplan-Meier survival curves, it was found that there was no significant difference in OS between the two groups, and the OS of patients in the RFA group appeared to be better than that of patients in the partial hepatectomy group. (P = 0.306). This disparity might be ascribed to the fact that the OS of colorectal cancer patients was affected by a variety of factors, such as the location of the primary lesion, the malignancy of the tumor, genotyping and other crucial factors. It might also be associated with the relatively small number of patients enrolled in this project. The Clinical Risk Score (CRS), also known as the Fong scoring system, was originally developed in 1999 by a research team at Memorial Sloan-Kettering Cancer Center (MSKCC) through retrospective analysis of clinical data from 1,001 patients with CRLM treated at their single institution( 14 ). For many years, this system had been widely regarded as the gold standard for prognostic stratification in CRLM management, owing to its robust methodological design and the substantial number of cases in the training cohort. It was clinically utilized to stratify patients and guide therapeutic decision-making based on individualized risk profiles (e.g., tumor number, size, nodal status of the primary tumor, disease-free interval, and carcinoembryonic antigen levels). However, with the emergence of modern chemotherapeutic regimens (e.g., FOLFOXIRI), novel targeted therapies (e.g., anti-EGFR/VEGF agents), and expanding surgical eligibility criteria for CRLM, accumulating evidence from contemporary studies has challenged its clinical utility. Recent several clinical investigations have highlighted discrepancies between CRS predictions and observed survival outcomes in the context of multimodal treatment approaches( 28 , 29 ). This paradigm shift may reflect limitations in the original scoring system's ability to incorporate molecular subtypes (e.g., RAS/BRAF mutations), tumor biology, or the impact of multidisciplinary treatment strategies. Furthermore, questions have been raised regarding its applicability to patients receiving neoadjuvant systemic therapies or undergoing parenchyma-sparing liver resection techniques. These findings underscore the necessity to reevaluate the clinical application of CRS in CRLM therapeutic decision-making. The expanding role of effective neoadjuvant therapies (e.g., chemotherapy combined with targeted agents), the substantial prognostic impact of genetic profiles (e.g., RAS/BRAF mutation status), and the heterogeneous efficacy of postoperative adjuvant treatments collectively demonstrate the limitations of current unidimensional scoring systems. Future predictive models must integrate dynamic variables such as: Tumor molecular profiling and microenvironment characteristics; Response metrics to neoadjuvant/adjuvant systemic therapies; Quantitative assessment of hepatic functional reserve; Radiomic signatures from pretreatment imaging; Longitudinal biomarker evolution (e.g., ctDNA clearance patterns). The development of such multidimensional artificial intelligence-driven platforms, incorporating both clinicopathologic parameters and real-time biological data, will be critical for generating personalized prognostic algorithms. This paradigm shift requires large-scale multicenter collaborations to establish continuously validated prognostic frameworks, ultimately enabling precision surgical oncology through adaptive, data-enriched decision-support tools. The findings of this study demonstrated that radiofrequency ablation (RFA) exhibited superior minimally invasive characteristics compared to partial hepatectomy, primarily evidenced by significantly reduced postoperative complications. The rates of bleeding, infection, liver failure, and biliary fistula and pleural effusion in the PH group were approximately 10%, 15%, and 8%, respectively, and the incidence of pleural effusion was relatively high after right hepatectomy. In the RFA Group, the incidence of bleeding, infection, and biliary fistula was 4%, 8%, and 2% respectively, and there was no hepatic failure or pleural effusion found in RFA group. Correspondingly, patients in the RFA group had shorter hospital stays and lower costs because of significant savings in anesthesia fees, pharmaceutical expenses, and post-discharge rehabilitation costs potentially. This investigation constitutes a retrospective case-control analysis designed to establish foundational evidence for future randomized controlled trials (RCTs). The methodological limitations inherent to this approach include:: 1. This study was a single-center study, and selection bias might occur in the enrolled patients;. 2.A total of 109 cases of CRLM were included in this study. The sample size was relatively small, and the statistical power was insufficient;. 3. Some variables showed correlation in univariate analysis but did not reach statistical significance in multivariate analysis, which may be related to the insufficient sample size; 4. This is not a randomized controlled multi-center study, and the clinical evidence level of the results is not strong. However, this study offered preliminary data for subsequent randomized controlled trials (RCTs), providing significant assistance in the determination of research feasibility, the selection of research indicators, and the design of sample size. In the future, we are also poised to collect the imaging data, clinical prognosis details, and genomic information of the relevant patients. Through deep learning by machines, the aim is to establish an effective predictive model for the treatment of CRLM or a decision-making model for treatment choices. 5. Conclusions The RFS of the PH group was significantly better than that of the RFA Group, but there was no significant difference in OS between the two groups. It is suggested that the patients with PH with or without RFA for CRLM may have better short - term control than the RFA group. There was no significant difference between the CRS high - score group and the CRS low - score group in terms of RFS and OS, which suggests that the CRS score might not accurately predict the RFS and the OS of CRLM patients after PH or RFA. Declarations Author Contribution Contributions: (I) Conception and design: X.Z. and H.n. L.(II) Administrative support:X.Z.(III) Provision of study materials or patients:X.Z. and Y.w. W.(IV) Collection and assembly of data:H.n. L. and Y.h. Z. and T.L.L. and Y.j. Z. and Y.t. L. and X.y. L.(V) Data analysis and interpretation:,F.y. C. and H.n. L.(VI) Manuscript writing: All authors(VII) Final approval of manuscript: All authors Consent to publish ： All authors agree to the publication and have signed the relevant consent form. Acknowledgments We appreciated all patients and their families who participated in this study. We also extended our heartfelt gratitude to our esteemed colleagues in the Departments of Radiology for their support and valuable consultations. Footnote Reporting Checklist: The authors have completed the STROBE reporting checklist. Funding:None Conflicts of Interest:All authors have completed the ICMJE uniform disclosure form. The authors have no conflicts of interest to declare. Ethical Statement:The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. The study was conducted in accordance with the Declaration of Helsinki and its subsequent amendments. The study protocol was approved by the Ethics and Scientific Trial Committee of the First Hospital of Xian Jiaotong University (XJTU1AF2024LSYY-396).This study was also registered at http://www.chictr.org.cn/index.aspx (ChiCTR-INR-2500103045) and individual consent for this retrospective analysis was waived. Informed consent:A sentence confirming that informed written consents (Consent to Participate ) were obtained from all participants. Data availability statement:All data generated or analysed during this study are included in this published article [and its supplementary information files]. References Cervantes A, Adam R, Roselló S, et al. Metastatic colorectal cancer: ESMO Clinical PracticeGuideline for diagnosis, treatment and follow-up. Ann Oncol Off J Eur Soc Med Oncol. 2023;34:10-32. Wang Y, Zhong X, He X, et al. Liver metastasis from colorectal cancer: pathogenetic development, immune landscape of the tumour microenvironment and therapeutic approaches. J Exp Clin Cancer Res CR. 2023;42:177. Torre LA, Siegel RL, Ward EM, et al. Global Cancer Incidence and Mortality Rates and Trends--An Update. Cancer Epidemiol Biomark Prev Publ Am Assoc Cancer Res Cosponsored AmSoc Prev Oncol. 2016;25:16-27. Yu X, Zhu L, Liu J, et al. Emerging Role of Immunotherapy for Colorectal Cancer with Liver Metastasis. OncoTargets Ther. 2020;13:11645-11658. Javed S, Benoist S, Devos P, et al. Prognostic factors of BRAF V600E colorectal cancer with liver metastases: a retrospective multicentric study. World J Surg Oncol. 2022;20:131. Kitano Y, Hayashi H, Matsumoto T, et al. Borderline resectable for colorectal liver metastases: Present status and future perspective. World J Gastrointest Surg. 2021;13:756-763. Bolhuis K, Kos M, van Oijen MGH, et al. Conversion strategies with chemotherapy plus targeted agents for colorectal cancer liver-only metastases: A systematic review. Eur J Cancer OxfEngl 1990. 2020;141:225-238. O’Connell RM, Hoti E. Challenges and Opportunities for Precision Surgery for Colorectal Liver Metastases. Cancers. 2024;16:2379. Akgül Ö, Çetinkaya E, Ersöz Ş, et al. Role of surgery in colorectal cancer liver metastases. World J Gastroenterol. 2014;20:6113-6122. Tang Y, Zhong H, Wang Y, et al. Efficacy of microwave ablation versus radiofrequency ablation in the treatment of colorectal liver metastases: A systematic review and meta-analysis. Clin Res Hepatol Gastroenterol. 2023;47:102182. Ceppa EP, Collings AT, Abdalla M, et al. SAGES/AHPBA guidelines for the use of microwave and radiofrequency liver ablation for the surgical treatment of hepatocellular carcinoma or colorectal liver metastases less than 5 cm. Surg Endosc. 2023;37:8991-9000. Chlorogiannis DD, Sotirchos VS, Sofocleous CT. Oncologic Outcomes after Percutaneous Ablation for Colorectal Liver Metastases: An Updated Comprehensive Review. Med Kaunas Lith. 2024;60:1536. Lam CSN, Bharwani AA, Chan EHY, et al. A machine learning model for colorectal liver metastasis post-hepatectomy prognostications. Hepatobiliary Surg Nutr. 2023;12:495-506. Fong Y, Fortner J, Sun RL, et al. Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases. Ann Surg. 1999;230:309-318;discussion:318-321. Mo S, Tang P, Luo W, et al. Patient-Derived Organoids from Colorectal Cancer with PairedLiver Metastasis Reveal Tumor Heterogeneity and Predict Response to Chemotherapy. Adv Sci Weinh Baden-Wurtt Ger. 2022;9:e2204097. Moretto R, Germani MM, Borelli B, et al. Predicting early recurrence after resection of initially unresectable colorectal liver metastases: the role of baseline and pre-surgery clinical, radiological and molecular factors in a real-life multicentre experience. ESMO Open. 2024;9:102991. Arnold M, Sierra MS, Laversanne M, et al. Global patterns and trends in colorectal cancer incidence and mortality. Gut. 2017;66:683-691. Ratti F, Cipriani F, Fiorentini G, et al. Evolution of Surgical Treatment of Colorectal Liver Metastases in the Real World: Single Center Experience in 1212 Cases. Cancers. 2021;13:1178. Ruers T, Van Coevorden F, Punt CJA, et al. Local Treatment of Unresectable Colorectal Liver Metastases: Results of a Randomized Phase II Trial. J Natl Cancer Inst. 2017;109:djx015. Hur H, Ko YT, Min BS, et al. Comparative study of resection and radiofrequency ablation in the treatment of solitary colorectal liver metastases. Am J Surg. 2009;197:728-736. Lee H, Heo JS, Cho YB, et al. Hepatectomy vs radiofrequency ablation for colorectal liver metastasis: a propensity score analysis. World J Gastroenterol. 2015;21:3300-3307. van Amerongen MJ, Jenniskens SFM, van den Boezem PB, et al. Radiofrequency ablation compared to surgical resection for curative treatment of patients with colorectal liver metastases - a meta-analysis. HPB. 2017;19:749-756. Puijk RS, Ruarus AH, Vroomen LGPH, et al. Colorectal liver metastases: surgery versus thermal ablation (COLLISION) - a phase III single-blind prospective randomized controlled trial. BMC Cancer. 2018;18:821. Gavriilidis P, Roberts KJ, de’Angelis N, et al. Recurrence and survival following microwave, radiofrequency ablation, and hepatic resection of colorectal liver metastases: A systematic review and network meta-analysis. Hepatobiliary Pancreat Dis Int HBPD INT. 2021;20:307-314. van Amerongen MJ, Jenniskens SFM, van den Boezem PB, et al. Radiofrequency ablation compared to surgical resection for curative treatment of patients with colorectal liver metastases - a meta-analysis. HPB. 2017;19:749-756. Liu M, Wang Y, Wang K, et al. Combined ablation and resection (CARe) for resectable colorectal cancer liver Metastases-A propensity score matching study. Eur J Surg Oncol J Eur SocSurg Oncol Br Assoc Surg Oncol. 2023;49:106931. Gunawardene A, Larsen P, Shekouh A, et al. Pre-operative carcinoembryonic antigen predictssurvival following colorectal cancer surgery with curative intent. ANZ J Surg. 2018;88:1311-1315. Ayez N, Lalmahomed ZS, van der Pool AEM, et al. Is the clinical risk score for patients with colorectal liver metastases still useable in the era of effective neoadjuvant chemotherapy? Ann Surg Oncol. 2011;18:2757-2763. Roberts KJ, White A, Cockbain A, et al. Performance of prognostic scores in predicting long-term outcome following resection of colorectal liver metastases. Br J Surg. 2014;101:856-866. Additional Declarations No competing interests reported. Supplementary Files rawdata.xlsx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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09:56:03","extension":"html","order_by":49,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":111634,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7703592/v1/a4566328ff2217aced0ca13e.html"},{"id":97868340,"identity":"747d7c36-f5e8-4a4f-90ad-390089a8912d","added_by":"auto","created_at":"2025-12-10 09:56:01","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":132964,"visible":true,"origin":"","legend":"\u003cp\u003eFlow diagram of patients identified and selected.CRLM: Colorectal liver metastasis; RFA: Radiofrequency ablation;PH:Partial hepatectomy\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-7703592/v1/a46cb563be9479dfc3bf0967.png"},{"id":97868338,"identity":"6632445e-f81a-45b3-a4cb-ea66d5723e55","added_by":"auto","created_at":"2025-12-10 09:56:01","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":61325,"visible":true,"origin":"","legend":"\u003cp\u003eKaplan-Meier survival analysis for relapse-free survival after radiofrequency ablation or partial hepatectomy for colorectal liver metastasis.RFA: Radiofrequency ablation;PH:Partial hepatectomy\u003c/p\u003e","description":"","filename":"Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-7703592/v1/2056f450d2f2d3499022cd26.png"},{"id":97899783,"identity":"42034940-abbc-458e-94b2-cadf289aae2e","added_by":"auto","created_at":"2025-12-10 15:44:52","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":50169,"visible":true,"origin":"","legend":"\u003cp\u003eKaplan-Meier survival analysis for overall survival after radiofrequency ablation or partial hepatectomy for colorectal liver metastasis.RFA: Radiofrequency ablation;PH:Partial hepatectomy\u003c/p\u003e","description":"","filename":"Figure3.png","url":"https://assets-eu.researchsquare.com/files/rs-7703592/v1/15e5c7efb55f5580afb97650.png"},{"id":97900038,"identity":"6130ee09-440d-4f8a-acb3-4a0c0d9d5417","added_by":"auto","created_at":"2025-12-10 15:45:10","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":84056,"visible":true,"origin":"","legend":"\u003cp\u003eRelapse-free survival after surgical treatment for colorectal liver metastasis by univariate analysis by Cox regression proportional hazard model (n = 109)\u003c/p\u003e","description":"","filename":"Figure4.png","url":"https://assets-eu.researchsquare.com/files/rs-7703592/v1/a19609353d5fc9027313528a.png"},{"id":97900571,"identity":"098024ad-c4c6-4028-8bcd-cb414e6c4d54","added_by":"auto","created_at":"2025-12-10 15:45:37","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":350904,"visible":true,"origin":"","legend":"\u003cp\u003eA-5J:Kaplan-Meier analysis of relapse-free survival in colorectal liver metastasis patients, stratified by characteristics. A:Age at diagnosis;B:Genderc;C.CEA;D:Whether bilobar involvement;E:Number of lines of first-line chemotherapy;F:Duration/cycle of first-line chemotherapy;G:Whether lymph node metastases;H:CA19-9;I:Maximum diameter of the hepatic lesion;J:ALBI classification\u003c/p\u003e","description":"","filename":"Figure5.png","url":"https://assets-eu.researchsquare.com/files/rs-7703592/v1/b6d102e4d4425337888b891d.png"},{"id":97868353,"identity":"ed835f3a-9b08-4d36-ba08-103a0493f4de","added_by":"auto","created_at":"2025-12-10 09:56:01","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":32033,"visible":true,"origin":"","legend":"\u003cp\u003eRelapse-free survival after surgical treatment for colorectal liver metastasis by multivariate analysis by Cox regression proportional hazard model (n = 109)\u003c/p\u003e","description":"","filename":"Figure6.png","url":"https://assets-eu.researchsquare.com/files/rs-7703592/v1/ec97b1ebf845e100ecc84f84.png"},{"id":97868344,"identity":"466c1a4d-4157-405f-ac61-efddb04aeec7","added_by":"auto","created_at":"2025-12-10 09:56:01","extension":"png","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":52962,"visible":true,"origin":"","legend":"\u003cp\u003eKaplan-Meier analysis of relapse-free survival in colorectal liver metastasis patients, stratified by CRS＜3 or CRS≥3.\u003c/p\u003e","description":"","filename":"Figure7.png","url":"https://assets-eu.researchsquare.com/files/rs-7703592/v1/51a093a6ce55c48a0c4527da.png"},{"id":97899282,"identity":"a414b704-1924-458b-ae77-44ae8cd2387a","added_by":"auto","created_at":"2025-12-10 15:42:34","extension":"png","order_by":8,"title":"Figure 8","display":"","copyAsset":false,"role":"figure","size":53918,"visible":true,"origin":"","legend":"\u003cp\u003eKaplan-Meier analysis of overall survival in colorectal liver metastasis patients, stratified by CRS＜3 or CRS≥3.\u003c/p\u003e","description":"","filename":"Figure8.png","url":"https://assets-eu.researchsquare.com/files/rs-7703592/v1/a7e87c0f75a59f0e853d2a24.png"},{"id":97898557,"identity":"8d1fd447-48be-48be-beb3-27930e133217","added_by":"auto","created_at":"2025-12-10 15:39:18","extension":"png","order_by":9,"title":"Figure 9","display":"","copyAsset":false,"role":"figure","size":89157,"visible":true,"origin":"","legend":"\u003cp\u003eOverall survival after surgical treatment for colorectal liver metastasis by Univariate analysis by Cox regression proportional hazard model (n = 109)\u003c/p\u003e","description":"","filename":"Figure9.png","url":"https://assets-eu.researchsquare.com/files/rs-7703592/v1/2a010d7d58e3e21151371f5a.png"},{"id":97899436,"identity":"6a980dc1-860d-4151-a9c1-4550c93af261","added_by":"auto","created_at":"2025-12-10 15:44:31","extension":"png","order_by":10,"title":"Figure 10","display":"","copyAsset":false,"role":"figure","size":319681,"visible":true,"origin":"","legend":"\u003cp\u003eA-10J:Kaplan-Meier analysis of overall survival in colorectal liver metastasis patients, stratified by characteristics. A:Age at diagnosis;B:Genderc;C.CEA;D:Whether bilobar involvement;E:Number of lines of first-line chemotherapy;F:Duration/cycle of first-line chemotherapy;G:Whether lymph node metastases;H:CA19-9;I:Maximum diameter of the hepatic lesion;J:ALBI classification\u003c/p\u003e","description":"","filename":"Figure10.png","url":"https://assets-eu.researchsquare.com/files/rs-7703592/v1/b3558cba7d577bd1f5eb85c9.png"},{"id":97868368,"identity":"c9e05f54-7b78-4f8f-a26c-8e0917949726","added_by":"auto","created_at":"2025-12-10 09:56:01","extension":"png","order_by":11,"title":"Figure 11","display":"","copyAsset":false,"role":"figure","size":19988,"visible":true,"origin":"","legend":"\u003cp\u003eOverall survival after surgical treatment for colorectal liver metastasis by multivariate analysis by Cox regression proportional hazard model (n = 109)\u003c/p\u003e","description":"","filename":"Figure11.png","url":"https://assets-eu.researchsquare.com/files/rs-7703592/v1/9eaedce173f5a821cc83d105.png"},{"id":97900377,"identity":"dcc5e8b4-66df-4135-84cb-c4074037d97e","added_by":"auto","created_at":"2025-12-10 15:45:26","extension":"png","order_by":12,"title":"Figure 12","display":"","copyAsset":false,"role":"figure","size":19892,"visible":true,"origin":"","legend":"\u003cp\u003eA-12B:A:Hospitalisation time;B:Hospitalisation costs\u003c/p\u003e","description":"","filename":"Figure12.png","url":"https://assets-eu.researchsquare.com/files/rs-7703592/v1/14cd704a02d3bad14f8b7366.png"},{"id":99316368,"identity":"cf806a02-9eb7-4066-bb87-f775269d0593","added_by":"auto","created_at":"2025-12-31 16:28:20","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1754630,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7703592/v1/09164ce8-109f-476e-bc4e-51e186f934a2.pdf"},{"id":97899222,"identity":"2940f49a-5f51-4d36-98a9-7a9ff3e412d6","added_by":"auto","created_at":"2025-12-10 15:42:13","extension":"xlsx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":33014,"visible":true,"origin":"","legend":"","description":"","filename":"rawdata.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-7703592/v1/489aab9a6bc8eb53be112034.xlsx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Radiofrequency ablation versus partial hepatectomy with or without radiofrequency ablation for colorectal cancer liver metastases","fulltext":[{"header":"Highlight box","content":"\u003cp\u003e\u003cstrong\u003eKey findings\u003c/strong\u003e\u003c/p\u003e\n\u003cul start=\"50\"\u003e\n \u003cli\u003eSurvival comparison: The PH group had a significantly longer median RFS (23 months) than the RFA group (14 months). However, there was no significant difference in OS between the two groups.CRS score: CRS score didn\u0026apos;t significantly affect RFS or OS, suggesting it may not be a reliable factor for surgical decisions.Complications and costs: RFA had fewer postoperative complications, shorter hospital stays, and lower costs compared to PH.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eWhat is known and what is new?\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cul start=\"50\"\u003e\n \u003cli\u003ePH benefits CRLM patients, and RFA is a minimally - invasive option. RFA has a higher recurrence rate but fewer complications.\u003c/li\u003e\n \u003cli\u003eThis study offers more evidence on RFS and OS differences between RFA and PH. It also challenges the use of the CRS score in modern treatment.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eWhat is the implication, and what should change now?\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cul start=\"50\"\u003e\n \u003cli\u003eImplications: Clinicians should balance short - term tumor control and complications. RFA is a good option for patients who can\u0026apos;t tolerate invasive surgery.Actions needed: Conduct large - scale multicenter RCTs. Develop comprehensive predictive models for better treatment decisions.\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"1. Introduction","content":"\u003cp\u003eColorectal cancer (CRC) is one of the malignancies with the highest incidence. Additionally, CRC patients may develop liver metastasis, which is the major cause of death(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).Approximately 15 to 25 percent of colorectal cancer patients present with liver metastasis at the time of diagnosis, and approximately 50 percent of patients will develop liver metastasis during the course of their disease(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).Colorectal liver metastases (CRLM) may be associated with several factors, including the direct connection between the colorectal region and the liver via the portal vein system, which is characterized by abundant blood flow, as well as the location and histological type of the primary tumor(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).Curative resection and systemic chemotherapy remain the standard treatment methods for patients with CRLM. Among them, 10\u0026ndash;20% CRLM patients are considered resectable, and 30\u0026ndash;40% are initially unresectable, but their tumours can shrink through transformative chemotherapy(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).For initially unresectable patients, after successful conversion and subsequent resection of liver metastases, the survival time of patients with CRLM can still be significantly prolonged(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e\u003cp\u003ePartial hepatectomy has been considered one of the most effective treatments for colorectal cancer liver metastases, with 20% \u0026minus;\u0026thinsp;30% of patients deriving long - term overall survival benefit from resection of liver metastases(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Radiofrequency ablation (RFA) is a thermal ablation technique that induces coagulative necrsis in the targeted liver tumor with the advantage of better preserved liver function(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).For CRLM patients with multiple intrahepatic metastases, a treatment strategy combining liver resection with radiofrequency ablation may be considered. Alternatively, radiofrequency ablation as a standalone intervention can also be employed for lesion management(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe Clinical Risk Score (CRS score), including five clinical factors: nodal status of primary, disease-free interval from the primary to discovery of the liver metastases of \u0026lt;\u0026thinsp;12 months, number of tumors\u0026thinsp;\u0026gt;\u0026thinsp;1, preoperative CEA level\u0026thinsp;\u0026gt;\u0026thinsp;200 ng/ml, and size of the largest tumor\u0026thinsp;\u0026gt;\u0026thinsp;5 cm, has been well accepted for long-term outcome prediction after hepatic resection for CRLM patients(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThis study endeavored to investigate the disparities between partial hepatectomy with or without radiofrequency ablation and radiofrequency ablation alone in the treatment of CRLM, and whether low CRS score (\u0026lt;\u0026thinsp;3) was significantly associated with better survival after artial hepatectomy with or without radiofrequency ablation and radiofrequency ablation alone via a retrospective controlled study.\u003c/p\u003e\u003cp\u003eWe present this article in accordance with the STORBE reporting checklist.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003e2.1 Study design and patient selection\u003c/h2\u003e\u003cp\u003eAs shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.We retrospectively collected and analyzed the clinical data and follow-up information of patients with colorectal cancer liver metastasis who were diagnosed and treated at the First Affiliated Hospital of Xi'an Jiaotong University from 2017 to 2024. The inclusion criteria for the patients enrolled in this study are as follows: 1. Age 18\u0026ndash;85 years old; 2. Complied with the diagnostic criteria for CRLM; 3. Received liver resection and/or radiofrequency ablation for CRLM; 4. Child-Pugh grade A or B liver function status; 5. No previous systemic or surgical treatment for primary liver cancer. Exclusion Criteria: 1. Radical therapeutic modalities was no longer considered safe or feasible; 2. The number of liver metastases from colorectal cancer exceeds 10; 3. the existence of extrahepatic metastatic lesions; 4. Inability to extract sufficient clinical or follow-up data; 5. Presence of autoimmune disease(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eAll the enrolled patients were categorized into the radiofrequency ablation group (RFA group) and the partial hepatectomy combined with or without radiofrequency ablation group (PH group). CRLM cases which only underwent RFA treatment were classified as the radiofrequency ablation group, while those receiving partial hepatectomy combined with or without RFA were PH group. We collected the clinicopathological characteristics of patients from both groups: Age, Gender, therapeutic modalities, CEA, tumor in a single liver lobe or in both lobes of the liver, history of preoperative chemotherapy, status of lymph node metastasis, serum CA199, maximum diameter of hepatic lesion, ALBI liver function classification. The Fong Clinical Risk Score (CRS) for Colorectal Cancer Recurrence, which included five clinical criteria: nodal status of primary, disease-free interval from the primary to discovery of the liver metastases of \u0026lt;\u0026thinsp;12 months, number of tumors\u0026thinsp;\u0026gt;\u0026thinsp;1, preoperative CEA level\u0026thinsp;\u0026gt;\u0026thinsp;200 ng/ml, and size of the largest tumor\u0026thinsp;\u0026gt;\u0026thinsp;5 cm, also carried out and each criteria was assigned one point, and the sum of each score constituted the total score. All patients were divided into two group: less than 3 points as low CRS score group and 3\u0026ndash;5 points as high CRS score group(\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003e2.2 Surgical therapeutic modalitiess\u003c/h2\u003e\u003cp\u003eRadiofrequency ablation: The RFA treatments incorporated in this study consisted of both percutaneous RFA and laparoscopic RFA for liver tumor lesions. Radiofrequency electrodes were inserted into the tumour tissue under the guidance of ultrasound. The generator was connected to start the ablation therapeutic modalities. Upon the conclusion of the radiofrequency ablation treatment, the radiofrequency electrode was withdrawn, and local compression bandaging was implemented at the puncture point for hemostasis. The liver metastatic tumor lesion treated in the RFA group did not entirely comply with the criteria for radiofrequency ablation as listed in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eAblatability criteria in this study.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"1\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAblatability criteria\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1. maximum CRLM size\u0026thinsp;\u0026le;\u0026thinsp;3 cm\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2. a tumor free margin of \u0026gt;\u0026thinsp;10 mm after RFA\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3. a minimum distance (lesion to major bile duct) of 15 mm is required to preserve the major bile ducts (common bile duct and main branches of the bile duct)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4. maximum total number of CRLM 10\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003ePartial hepatectomy: Partial hepatectomy encompassed laparoscopic partial hepatectomy and open partial hepatectomy. During PH, the surgeon excised all the lesions that were not amenable to RFA (ablatability criteria was shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) and those located on the liver surface. Intraoperative ultrasound was employed to search for and localize the liver metastatic tumor foci. All surgical margins were required to achieve R0 resection, but there was no demand for a considerable distance between the margin and the tumor boundary.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003e2.3 Follow - up information\u003c/h2\u003e\u003cp\u003eAll patients were underwent routine follow-up examinations including imaging and laboratory tests every 3 months for the first year and every 6 months postoperatively. Follow-up cross-sectional imaging included at least an abdominal enhanced CT or Gd-EOB-DTPA MRI at the given time-points. Quality of life questionnaires were assessed at baseline, every 3 months for the first year and every 6 months\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003e2.4 Primary and secondary objectives\u003c/h2\u003e\u003cp\u003eThe main objective in this study was to figure out which treatment modality, RFA alone or partial hepatectomy with or without RFA, can prolong the recurrence-free survival time of intrahepatic tumors or overall survival for resectable or radiofrequency ablation (RFA)-treatable CRLM patients. The secondary points were whether patients with CRLM having a CRS score higher than 3 were truly ineligible for resection of liver metastases or radiofrequency ablation treatment. The other factors including procedural morbidity and mortality and cost-effectiveness ratio (ICER) were also determined in this study.\u003c/p\u003e\u003cp\u003eRelapse -free survival (RFS) was defined as the time from liver surgery to recurrence of the tumour lesion or death from any cause. Overall survival (OS) was defined as the time from liver surgery to death from any cause.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003e2.5 Statistical analyses\u003c/h2\u003e\u003cp\u003eIt is expected that 10 variables will be considered, and based on a 10-20-fold relationship, it is expected that a sample size of approximately 100 will be required .All clinicopathological and procedural variables were comprehensively described and analyzed. Continuous variables were summarized using standard statistical methods, including means, standard deviations, medians, and ranges. Categorical variables will be presented as frequencies and proportions. Univariate survival analysis was carried out using the Kaplan-Meier survival curves. Differences in survival durations were evaluated using the log-rank test. For multivariate analysis, Cox proportional hazards regression was employed to estimate hazard ratios (HR). The significance of differences for continuous and categorical data was assessed using the Mann-Whitney U test and the Chi-square test, respectively. P-values below 0.05 will be considered significant. All statistical analyses were performed using SPSS Statistics version 25 (IBM Corporation, Armonk, New York, USA), GraphPad Prism version 10 and RStudio version 4.4.3. The 95 95% CI confidence intervals for the risk ratios (HR) were estimated using the Cox proportional risk model, and the effects of clinical prognostic variables on RFS and OS were assessed by univariate and multivariate Cox regression analyses using either the log - rank test or the weighted Wilcoxon test, depending on the type of information.\u003c/p\u003e\u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003e3.1 Study population\u003c/h2\u003e\u003cp\u003eFrom November 2017 to September 2024, a total of 409 cases of patients with liver metastases were admitted to the Department of Hepatobiliary Surgery and the Department of General Surgery of the First Affiliated Hospital of Xi'an Jiaotong University. A total of 190 patients with CRLM were excluded due to failure to meet the criteria for radical resection or radiofrequency ablation of liver metastases. 39 patients were excluded from the study because of the absence of standard follow-up data, and Thirty-five patients were lost to follow-up during the early postoperative phase. 31 patients, despite meeting the criteria for radical resection of liver metastases or radiofrequency ablation, did not undergo the corresponding treatments but only received systemic chemotherapy. 7 patients were excluded on account of receiving selective internal radiotherapy with yttrium-90. Finally, there were a total of 109 patients with CRLM incorporated into this retrospective cohort control study. Among them, 50 patients with CRLM solely underwent radical RFA therapy and constituted the RFA group. 59 patients with CRLM received partial liver resection combined with or without radiofrequency ablation therapy and formed the PH group.The detailed baseline characteristics of all 109 CRLM patients are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. There were no significant differences in the demography, tumor characteristics and laboratory test results between the two groups of CRLM patients.. In accordance with the CRS scoring standards, 39 cases of CRLM were categorized into the high CRS score group, whereas 73 cases of CRLM were in the low CRS score group.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCharacteristics of CRLM patients stratified by therapeutic modalitiess group n(%).RFA: Radiofrequency ablation; CEA: Carcinoembryonic antigen.CA19\u0026ndash;9: A carbohydrate antigen and also a tumor marker, used in the analysis of the patient's condition in the article, but its relationship with RFS and OS is not significant.ALBI: Abbreviation for Albumin - bilirubin, used in the article to evaluate the patient's liver function status.All variables were dichotomised and continuous variables were dichotomised by median.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFactors\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRFA\u0026nbsp;Group\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePH\u0026nbsp;Group\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge\u0026nbsp;at\u0026nbsp;diagnosis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026le;\u0026thinsp;60years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e29\u0026nbsp;(58.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e29\u0026nbsp;(49.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.465\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026gt;60years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e21\u0026nbsp;(42.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e30\u0026nbsp;(50.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e34\u0026nbsp;(68.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e38\u0026nbsp;(64.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.848\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e16\u0026nbsp;(32.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e21\u0026nbsp;(35.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCEA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026le;\u0026thinsp;5.81ng/ml\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e27\u0026nbsp;(54.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e28\u0026nbsp;(47.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.625\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026gt;5.81ng/ml\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e23\u0026nbsp;(46.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e31\u0026nbsp;(52.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWhether\u0026nbsp;bilobar\u0026nbsp;involvement\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e34\u0026nbsp;(68.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e44\u0026nbsp;(74.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.586\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e16\u0026nbsp;(32.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e15\u0026nbsp;(25.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNumber\u0026nbsp;of\u0026nbsp;lines\u0026nbsp;of\u0026nbsp;first-line\u0026nbsp;chemotherapy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026le;\u0026thinsp;1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e35\u0026nbsp;(70.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e41\u0026nbsp;(69.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026gt;1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e15\u0026nbsp;(30.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e18\u0026nbsp;(30.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDuration/cycle\u0026nbsp;of\u0026nbsp;first-line\u0026nbsp;chemotherapy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026le;\u0026thinsp;7cycle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e27\u0026nbsp;(54.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e28\u0026nbsp;(47.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.625\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026gt;7cycle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e23\u0026nbsp;(46.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e31\u0026nbsp;(52.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWhether\u0026nbsp;lymph\u0026nbsp;node\u0026nbsp;metastases\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e36\u0026nbsp;(72.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e42\u0026nbsp;(71.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e14\u0026nbsp;(28.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e17\u0026nbsp;(28.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCA19\u0026minus;9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026le;\u0026thinsp;20U/ml\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e30\u0026nbsp;(60.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e25\u0026nbsp;(43.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.119\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026gt;20U/ml\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e20\u0026nbsp;(40.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e33\u0026nbsp;(56.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMaximum\u0026nbsp;diameter\u0026nbsp;of\u0026nbsp;the\u0026nbsp;hepatic\u0026nbsp;lesion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026le;\u0026thinsp;2.2cm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e32\u0026nbsp;(64.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e23\u0026nbsp;(39.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.016\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026gt;2.2cm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e18\u0026nbsp;(36.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e36\u0026nbsp;(61.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eALBI\u0026nbsp;classification\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026le;\u0026minus;15.06g/L\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e25\u0026nbsp;(50.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e30\u0026nbsp;(50.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026gt;\u0026minus;15.06g/L\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e25\u0026nbsp;(50.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e29\u0026nbsp;(49.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\u003ch2\u003e3.2 Intrahepatic tumour RFS\u003c/h2\u003e\u003cp\u003eAs shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e,the RFS of intrahepatic lesions in the PH group (median RFS: 23 months) was significantly superior to that in the RFA group (median RFS: 14 months) (P\u0026thinsp;=\u0026thinsp;0.013, HR\u0026thinsp;=\u0026thinsp;0.509, 95% CI: 0.299\u0026ndash;0.864). It supported that in contrast to RFA therapy, PH for CRLM patients had a lower postoperative recurrence.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eTo explore whether patients with CRLM having a CRS score higher than or equal to 3 had the unfavorable RFS after radiofrequency ablation or partial hepatectomy of liver metastase lesions, we compared the RFS of patients with a CRS score greater than or equal to 3 and those with a score less than 3 in this study. It was found that the RFS of CRLM patients with a high CRS (median RFS: 13 months) was not poor (P\u0026thinsp;=\u0026thinsp;0.349, HR: 1.308, 95% CI: 0.769\u0026ndash;2.223; Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e), compared to those from low CRS score group (median RFS: 17 months),which suggested that the CRS score might not accurately predict the RFS of CRLM patients after partial hepatectomy or radiofrequency ablation.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eSubsequently, we carried out a univariate analysis regarding the non-recurrence of intrahepatic tumors in CRLM. As presented in Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003eA-\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003eJ, it was found that compared with other demographic characteristics and clinical factors, only partial hepatectomy significantly affected the RFS of intrahepatic tumors for CRLM.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eFive prognostic factors with a certain degree of statistical significance (P\u0026thinsp;\u0026lt;\u0026thinsp;0.20) were selected from the outcome of the univariate analysis for COX multivariate regression analysis, including therapeutic modalities (RFA vs PH), Age at diagnosis (\u0026le;\u0026thinsp;60 years vs\u0026thinsp;\u0026gt;\u0026thinsp;60 years), Whether bilobar involvement (No vs Yes), Number of lines of first - line chemotherapy (\u0026le;\u0026thinsp;1 vs\u0026thinsp;\u0026gt;\u0026thinsp;1), CEA (\u0026le;\u0026thinsp;5.81 ng/ml vs\u0026thinsp;\u0026gt;\u0026thinsp;5.81 ng/ml).\u003c/p\u003e\u003cp\u003eAs presented in Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003e ,COX multivariate analysis revealed that the treatment modality (P\u0026thinsp;=\u0026thinsp;0.021, HR\u0026thinsp;=\u0026thinsp;1.859, 95% CI: 1.098\u0026ndash;3.146) and the serum CEA level (P\u0026thinsp;=\u0026thinsp;0.041, HR\u0026thinsp;=\u0026thinsp;0.605, 95% CI: 0.358\u0026ndash;1.024) were independent influencing factors for the post-surgical RFS of intrahepatic tumors for CRLM.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003e3.3 Overall survival\u003c/h2\u003e\u003cp\u003eAs shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig7\" class=\"InternalRef\"\u003e7\u003c/span\u003e,the OS of intrahepatic lesions in the RFA Group (median OS: undefined)VS the PH group (median OS: 62 months) (P\u0026thinsp;=\u0026thinsp;0.306, HR\u0026thinsp;=\u0026thinsp;0.406, 95% CI: 0.141\u0026ndash;1.174). It supported that there was no significant difference in OS between the RFA group and the PH group.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eTo explore whether patients with CRLM having a CRS score higher than or equal to 3 had the unfavorable OS after radiofrequency ablation or partial hepatectomy of liver metastase lesions, we compared the OS of patients with a CRS score greater than or equal to 3 and those with a score less than 3 in this study. It was found that the OS of CRLM patients with a high CRS was not poor (P: 0.711, HR: 0.636, 95% Cl: 0.190 to 2.124; Fig.\u0026nbsp;\u003cspan refid=\"Fig8\" class=\"InternalRef\"\u003e8\u003c/span\u003e), compared to those from low CRS score group. which suggested that the CRS score might not accurately predict the OS of CRLM patients after partial hepatectomy or radiofrequency ablation.Medain OS of both groups were undefined, because the mortality of patients in both groups did not exceed half.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eSubsequently, we carried out a univariate analysis regarding the OS in CRLM patients. As presented in Fig.\u0026nbsp;\u003cspan refid=\"Fig9\" class=\"InternalRef\"\u003e9\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig10\" class=\"InternalRef\"\u003e10\u003c/span\u003eA-\u003cspan refid=\"Fig10\" class=\"InternalRef\"\u003e10\u003c/span\u003eJ, it was found that compared with other demographic characteristics and clinical factors, only partial hepatectomy significantly affected the OS of CRLM patients.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eFive prognostic factors with a certain degree of statistical significance (P\u0026thinsp;\u0026lt;\u0026thinsp;0.20) were selected from the outcome of the univariate analysis for COX multivariate regression analysis, including Therapeutic modalities (RFA Group vs PH group), Gender (Male vs Female), Whether bilobar involvement (No vs Yes), CA19\u0026ndash;9 (\u0026le;\u0026thinsp;20 U/ml vs\u0026thinsp;\u0026gt;\u0026thinsp;20 U/ml), and CEA (\u0026le;\u0026thinsp;5.81 ng/ml vs\u0026thinsp;\u0026gt;\u0026thinsp;5.81 ng/ml).\u003c/p\u003e\u003cp\u003eAs presented in Fig.\u0026nbsp;\u003cspan refid=\"Fig11\" class=\"InternalRef\"\u003e11\u003c/span\u003e ,COX multivariate analysis revealed that no independent prognostic factor for OS of CRLM patients.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003e3.4 Safety assessment and cost - effectiveness\u003c/h2\u003e\u003cp\u003eThere were no treatment-related deaths among the patients enrolled in this study..As shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, there were 4 cases of intra-abdominal infection (8%), and 1 case of bile leakage (2%) in the RFA group. No adverse reactions such as pleural effusion and liver failure occurred. In the PH group, 9 cases (15%) of abdominal infection, 5 cases (8%) of liver failure, 3 cases (5%) of bile leakage, and 12 cases (20%) of pleural effusion occurred.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eAdverse reaction after surgical treatment for colorectal liver metastasis n(%).RFA: Radiofrequency ablation;PH:Partial hepatectomy\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTRAE\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRFA\u0026nbsp;Group\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePH\u0026nbsp;Group\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInfection\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLiver\u0026nbsp;failure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0(0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBile\u0026nbsp;fistula\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePleural\u0026nbsp;effusion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0(0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12(\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e20\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe median length of hospital stay for patients in the RFA group was 5 days (ranging from 3 days to 7 days). The hospitalization expenses of patients in the RFA group varied considerably, ranging from \u0026yen; 20,000 to \u0026yen; 60,000, with an average expense of \u0026yen; 40,000. The duration of hospital stay for patients in the PH group (median length of hospital stay: 11 days) was significantly prolonged compared with the RFA group (Fig.\u0026nbsp;\u003cspan refid=\"Fig12\" class=\"InternalRef\"\u003e12\u003c/span\u003eA).The hospitalization costs of the PH group were significantly greater than those of the RFA group (Fig.\u0026nbsp;\u003cspan refid=\"Fig12\" class=\"InternalRef\"\u003e12\u003c/span\u003eB).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eIt is currently widely acknowledged that surgical resection for locally resectable liver metastases from colorectal cancer can evidently prolong the survival time of patients with 40%-50% of 5-year post-surgical survival rate(17,18). Radiofrequency ablation is also a minimally invasive local therapeutic modality that is extensively applied in the treatment of various liver metastases. The CLOCC study demonstrates that radiofrequency ablation in combination with chemotherapy for unresectable liver metastases yields better therapeutic outcomes for CRLM than chemotherapy alone(19). Regarding resectable liver metastases, there is a controversy as to whether partial hepatectomy or radiofrequency ablation is superior. A multitude of studies demonstrated that the recurrence rate of intrahepatic tumors and the overall tumor recurrence rate subsequent to RFA treatment were higher in contrast to those after partial hepatectomy(\u003cspan additionalcitationids=\"CR21\" citationid=\"CR18\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e22\u003c/span\u003e). Nevertheless, RFA treatment exhibits a lower incidence of postoperative complications and lower hospitalization expenses. Some research has put forward that the overall survival time of patients with \u0026le;\u0026thinsp;3cm CRLM treated with RFA and partial hepatectomy was comparable(\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e24\u003c/span\u003e), yet other studies have indicated that the overall survival time of patients with colorectal cancer liver metastases treated with partial hepatectomy was superior to that of those treated with RFA(\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e25\u003c/span\u003e). And for patients with multiple CRLM, combined ablation and partial hepatectomy were found to be a superior treatment strategy compared to hepatectomy alone, as it avoided major hepatectomy, achieved better surgical outcomes, and provided comparable oncologic results(\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e26\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThis study intended to explore, through a retrospective cohort study, which approach was superior for the treatment of CRLM: RFA or PH combined with or without RFA.and also to evaluate the prognostic impact of the clinicopathological factors and CRS score. The median time to recurrence-free of intrahepatic lesions in the PH group (23 months) was higher than that in the RFA group (14 months). And analysis of Kaplan-Meier survival curves also supported that partial hepatectomy had a significant advantage in controlling intrahepatic tumor progression. Cox multivariate analysis showed that the therapeutic modalities and serum CEA level were independent risk factors affecting intrahepatic tumor PFS. Some RFA procedures may fail to completely ablate the tumor, while hepatectomy can guarantee R0 resection of the tumor. This might be the cause for the longer recurrence-free survival time of intrahepatic tumors in the hepatectomy group compared to that in the RFA group. Consistent with the findings of multiple previous studies(\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e27\u003c/span\u003e), this study also discovered that a relatively high preoperative plasma CEA level was an unfavorable prognostic factor after colorectal cancer surgery. This might be attributed to the correlation between CEA and poorer tumor differentiation or staging.\u003c/p\u003e\u003cp\u003eAlthough the PFS of intrahepatic lesions in the PH group was superior to that in the RFA group, upon analyzing the Kaplan-Meier survival curves, it was found that there was no significant difference in OS between the two groups, and the OS of patients in the RFA group appeared to be better than that of patients in the partial hepatectomy group. (P\u0026thinsp;=\u0026thinsp;0.306). This disparity might be ascribed to the fact that the OS of colorectal cancer patients was affected by a variety of factors, such as the location of the primary lesion, the malignancy of the tumor, genotyping and other crucial factors. It might also be associated with the relatively small number of patients enrolled in this project.\u003c/p\u003e\u003cp\u003eThe Clinical Risk Score (CRS), also known as the Fong scoring system, was originally developed in 1999 by a research team at Memorial Sloan-Kettering Cancer Center (MSKCC) through retrospective analysis of clinical data from 1,001 patients with CRLM treated at their single institution(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). For many years, this system had been widely regarded as the gold standard for prognostic stratification in CRLM management, owing to its robust methodological design and the substantial number of cases in the training cohort. It was clinically utilized to stratify patients and guide therapeutic decision-making based on individualized risk profiles (e.g., tumor number, size, nodal status of the primary tumor, disease-free interval, and carcinoembryonic antigen levels).\u003c/p\u003e\u003cp\u003eHowever, with the emergence of modern chemotherapeutic regimens (e.g., FOLFOXIRI), novel targeted therapies (e.g., anti-EGFR/VEGF agents), and expanding surgical eligibility criteria for CRLM, accumulating evidence from contemporary studies has challenged its clinical utility. Recent several clinical investigations have highlighted discrepancies between CRS predictions and observed survival outcomes in the context of multimodal treatment approaches(\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e29\u003c/span\u003e). This paradigm shift may reflect limitations in the original scoring system's ability to incorporate molecular subtypes (e.g., RAS/BRAF mutations), tumor biology, or the impact of multidisciplinary treatment strategies. Furthermore, questions have been raised regarding its applicability to patients receiving neoadjuvant systemic therapies or undergoing parenchyma-sparing liver resection techniques. These findings underscore the necessity to reevaluate the clinical application of CRS in CRLM therapeutic decision-making. The expanding role of effective neoadjuvant therapies (e.g., chemotherapy combined with targeted agents), the substantial prognostic impact of genetic profiles (e.g., RAS/BRAF mutation status), and the heterogeneous efficacy of postoperative adjuvant treatments collectively demonstrate the limitations of current unidimensional scoring systems. Future predictive models must integrate dynamic variables such as: Tumor molecular profiling and microenvironment characteristics; Response metrics to neoadjuvant/adjuvant systemic therapies; Quantitative assessment of hepatic functional reserve; Radiomic signatures from pretreatment imaging; Longitudinal biomarker evolution (e.g., ctDNA clearance patterns). The development of such multidimensional artificial intelligence-driven platforms, incorporating both clinicopathologic parameters and real-time biological data, will be critical for generating personalized prognostic algorithms. This paradigm shift requires large-scale multicenter collaborations to establish continuously validated prognostic frameworks, ultimately enabling precision surgical oncology through adaptive, data-enriched decision-support tools.\u003c/p\u003e\u003cp\u003eThe findings of this study demonstrated that radiofrequency ablation (RFA) exhibited superior minimally invasive characteristics compared to partial hepatectomy, primarily evidenced by significantly reduced postoperative complications. The rates of bleeding, infection, liver failure, and biliary fistula and pleural effusion in the PH group were approximately 10%, 15%, and 8%, respectively, and the incidence of pleural effusion was relatively high after right hepatectomy. In the RFA Group, the incidence of bleeding, infection, and biliary fistula was 4%, 8%, and 2% respectively, and there was no hepatic failure or pleural effusion found in RFA group. Correspondingly, patients in the RFA group had shorter hospital stays and lower costs because of significant savings in anesthesia fees, pharmaceutical expenses, and post-discharge rehabilitation costs potentially.\u003c/p\u003e\u003cp\u003eThis investigation constitutes a retrospective case-control analysis designed to establish foundational evidence for future randomized controlled trials (RCTs). The methodological limitations inherent to this approach include:: 1. This study was a single-center study, and selection bias might occur in the enrolled patients;. 2.A total of 109 cases of CRLM were included in this study. The sample size was relatively small, and the statistical power was insufficient;. 3. Some variables showed correlation in univariate analysis but did not reach statistical significance in multivariate analysis, which may be related to the insufficient sample size; 4. This is not a randomized controlled multi-center study, and the clinical evidence level of the results is not strong. However, this study offered preliminary data for subsequent randomized controlled trials (RCTs), providing significant assistance in the determination of research feasibility, the selection of research indicators, and the design of sample size. In the future, we are also poised to collect the imaging data, clinical prognosis details, and genomic information of the relevant patients. Through deep learning by machines, the aim is to establish an effective predictive model for the treatment of CRLM or a decision-making model for treatment choices.\u003c/p\u003e"},{"header":"5. Conclusions","content":"\u003cp\u003eThe RFS of the PH group was significantly better than that of the RFA Group, but there was no significant difference in OS between the two groups. It is suggested that the patients with PH with or without RFA for CRLM may have better short - term control than the RFA group. There was no significant difference between the CRS high - score group and the CRS low - score group in terms of RFS and OS, which suggests that the CRS score might not accurately predict the RFS and the OS of CRLM patients after PH or RFA.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eContributions: (I) Conception and design: X.Z. and H.n. L.(II) Administrative support:X.Z.(III) Provision of study materials or patients:X.Z. and Y.w. W.(IV) Collection and assembly of data:H.n. L. and Y.h. Z. and T.L.L. and Y.j. Z. and Y.t. L. and X.y. L.(V) Data analysis and interpretation:,F.y. C. and H.n. L.(VI) Manuscript writing: All authors(VII) Final approval of manuscript: All authors\u003c/p\u003e\u003cp\u003e\u003cstrong\u003e\u003cstrong\u003eConsent to publish\u003c/strong\u003e\u003cstrong\u003e：\u003c/strong\u003e\u003c/strong\u003eAll authors agree to the publication and have signed the relevant consent form.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe appreciated all patients and their families who participated in this study. We also extended our heartfelt gratitude to our esteemed colleagues in the Departments of Radiology for their support and valuable consultations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFootnote\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eReporting Checklist: The authors have completed the STROBE reporting checklist.\u003c/p\u003e\n\u003cp\u003eFunding:None\u003c/p\u003e\n\u003cp\u003eConflicts of Interest:All authors have completed the ICMJE uniform disclosure form. The authors have no conflicts of interest to declare.\u003c/p\u003e\n\u003cp\u003eEthical Statement:The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. The study was conducted in accordance with the Declaration of Helsinki and its subsequent amendments. The study protocol was approved by the Ethics and Scientific Trial Committee of the First Hospital of Xian Jiaotong University (XJTU1AF2024LSYY-396).This study was also registered at http://www.chictr.org.cn/index.aspx (ChiCTR-INR-2500103045) and individual consent for this retrospective analysis was waived.\u003c/p\u003e\n\u003cp\u003eInformed consent:A sentence confirming that informed written consents (Consent to Participate ) were obtained from all participants.\u003c/p\u003e\n\u003cp\u003eData availability statement:All data generated or analysed during this study are included in this published article [and its supplementary information files].\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eCervantes A, Adam R, Rosell\u0026oacute; S, et al. Metastatic colorectal cancer: ESMO Clinical PracticeGuideline for diagnosis, treatment and follow-up. Ann Oncol Off J Eur Soc Med Oncol. 2023;34:10-32.\u003c/li\u003e\n\u003cli\u003eWang Y, Zhong X, He X, et al. Liver metastasis from colorectal cancer: pathogenetic development, immune landscape of the tumour microenvironment and therapeutic approaches. J Exp Clin Cancer Res CR. 2023;42:177. \u003c/li\u003e\n\u003cli\u003eTorre LA, Siegel RL, Ward EM, et al. Global Cancer Incidence and Mortality Rates and Trends--An Update. Cancer Epidemiol Biomark Prev Publ Am Assoc Cancer Res Cosponsored AmSoc Prev Oncol. 2016;25:16-27.\u003c/li\u003e\n\u003cli\u003eYu X, Zhu L, Liu J, et al. Emerging Role of Immunotherapy for Colorectal Cancer with Liver Metastasis. OncoTargets Ther. 2020;13:11645-11658. \u003c/li\u003e\n\u003cli\u003eJaved S, Benoist S, Devos P, et al. Prognostic factors of BRAF V600E colorectal cancer with liver metastases: a retrospective multicentric study. World J Surg Oncol. 2022;20:131. \u003c/li\u003e\n\u003cli\u003eKitano Y, Hayashi H, Matsumoto T, et al. Borderline resectable for colorectal liver metastases: Present status and future perspective. World J Gastrointest Surg. 2021;13:756-763. \u003c/li\u003e\n\u003cli\u003eBolhuis K, Kos M, van Oijen MGH, et al. Conversion strategies with chemotherapy plus targeted agents for colorectal cancer liver-only metastases: A systematic review. Eur J Cancer OxfEngl 1990. 2020;141:225-238. \u003c/li\u003e\n\u003cli\u003eO\u0026rsquo;Connell RM, Hoti E. Challenges and Opportunities for Precision Surgery for Colorectal Liver Metastases. Cancers. 2024;16:2379. \u003c/li\u003e\n\u003cli\u003eAkg\u0026uuml;l \u0026Ouml;, \u0026Ccedil;etinkaya E, Ers\u0026ouml;z Ş, et al. Role of surgery in colorectal cancer liver metastases. World J Gastroenterol. 2014;20:6113-6122. \u003c/li\u003e\n\u003cli\u003eTang Y, Zhong H, Wang Y, et al. Efficacy of microwave ablation versus radiofrequency ablation in the treatment of colorectal liver metastases: A systematic review and meta-analysis. Clin Res Hepatol Gastroenterol. 2023;47:102182. \u003c/li\u003e\n\u003cli\u003eCeppa EP, Collings AT, Abdalla M, et al. SAGES/AHPBA guidelines for the use of microwave and radiofrequency liver ablation for the surgical treatment of hepatocellular carcinoma or colorectal liver metastases less than 5 cm. Surg Endosc. 2023;37:8991-9000. \u003c/li\u003e\n\u003cli\u003eChlorogiannis DD, Sotirchos VS, Sofocleous CT. Oncologic Outcomes after Percutaneous Ablation for Colorectal Liver Metastases: An Updated Comprehensive Review. Med Kaunas Lith. 2024;60:1536. \u003c/li\u003e\n\u003cli\u003eLam CSN, Bharwani AA, Chan EHY, et al. A machine learning model for colorectal liver metastasis post-hepatectomy prognostications. Hepatobiliary Surg Nutr. 2023;12:495-506.\u003c/li\u003e\n\u003cli\u003eFong Y, Fortner J, Sun RL, et al. Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases. Ann Surg. 1999;230:309-318;discussion:318-321. \u003c/li\u003e\n\u003cli\u003eMo S, Tang P, Luo W, et al. Patient-Derived Organoids from Colorectal Cancer with PairedLiver Metastasis Reveal Tumor Heterogeneity and Predict Response to Chemotherapy. Adv Sci Weinh Baden-Wurtt Ger. 2022;9:e2204097.\u003c/li\u003e\n\u003cli\u003eMoretto R, Germani MM, Borelli B, et al. Predicting early recurrence after resection of initially unresectable colorectal liver metastases: the role of baseline and pre-surgery clinical, radiological and molecular factors in a real-life multicentre experience. ESMO Open. 2024;9:102991.\u003c/li\u003e\n\u003cli\u003eArnold M, Sierra MS, Laversanne M, et al. Global patterns and trends in colorectal cancer incidence and mortality. Gut. 2017;66:683-691. \u003c/li\u003e\n\u003cli\u003eRatti F, Cipriani F, Fiorentini G, et al. Evolution of Surgical Treatment of Colorectal Liver Metastases in the Real World: Single Center Experience in 1212 Cases. Cancers. 2021;13:1178.\u003c/li\u003e\n\u003cli\u003eRuers T, Van Coevorden F, Punt CJA, et al. Local Treatment of Unresectable Colorectal Liver Metastases: Results of a Randomized Phase II Trial. J Natl Cancer Inst. 2017;109:djx015. \u003c/li\u003e\n\u003cli\u003eHur H, Ko YT, Min BS, et al. Comparative study of resection and radiofrequency ablation in the treatment of solitary colorectal liver metastases. Am J Surg. 2009;197:728-736. \u003c/li\u003e\n\u003cli\u003eLee H, Heo JS, Cho YB, et al. Hepatectomy vs radiofrequency ablation for colorectal liver metastasis: a propensity score analysis. World J Gastroenterol. 2015;21:3300-3307. \u003c/li\u003e\n\u003cli\u003evan Amerongen MJ, Jenniskens SFM, van den Boezem PB, et al. Radiofrequency ablation compared to surgical resection for curative treatment of patients with colorectal liver metastases - a meta-analysis. HPB. 2017;19:749-756. \u003c/li\u003e\n\u003cli\u003ePuijk RS, Ruarus AH, Vroomen LGPH, et al. Colorectal liver metastases: surgery versus thermal ablation (COLLISION) - a phase III single-blind prospective randomized controlled trial. BMC Cancer. 2018;18:821. \u003c/li\u003e\n\u003cli\u003eGavriilidis P, Roberts KJ, de\u0026rsquo;Angelis N, et al. Recurrence and survival following microwave, radiofrequency ablation, and hepatic resection of colorectal liver metastases: A systematic review and network meta-analysis. Hepatobiliary Pancreat Dis Int HBPD INT. 2021;20:307-314. \u003c/li\u003e\n\u003cli\u003evan Amerongen MJ, Jenniskens SFM, van den Boezem PB, et al. Radiofrequency ablation compared to surgical resection for curative treatment of patients with colorectal liver metastases - a meta-analysis. HPB. 2017;19:749-756. \u003c/li\u003e\n\u003cli\u003eLiu M, Wang Y, Wang K, et al. Combined ablation and resection (CARe) for resectable colorectal cancer liver Metastases-A propensity score matching study. Eur J Surg Oncol J Eur SocSurg Oncol Br Assoc Surg Oncol. 2023;49:106931. \u003c/li\u003e\n\u003cli\u003eGunawardene A, Larsen P, Shekouh A, et al. Pre-operative carcinoembryonic antigen predictssurvival following colorectal cancer surgery with curative intent. ANZ J Surg. 2018;88:1311-1315. \u003c/li\u003e\n\u003cli\u003eAyez N, Lalmahomed ZS, van der Pool AEM, et al. Is the clinical risk score for patients with colorectal liver metastases still useable in the era of effective neoadjuvant chemotherapy? Ann Surg Oncol. 2011;18:2757-2763. \u003c/li\u003e\n\u003cli\u003eRoberts KJ, White A, Cockbain A, et al. Performance of prognostic scores in predicting long-term outcome following resection of colorectal liver metastases. Br J Surg. 2014;101:856-866. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"radiofrequency ablation, partial hepatectomy, colorectal cancer liver metastases, prognosis, CRS","lastPublishedDoi":"10.21203/rs.3.rs-7703592/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7703592/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eColorectal cancer (CRC) is a common malignancy. 20\u0026ndash;40% of bowel cancers are accompanied by liver metastases, and liver failure due to liver metastases is the most common cause of death in bowel cancer patients. Radiofrequency ablation (RFA) and partial hepatectomy (PH) are two commonly used treatments for colorectal cancer liver metastases. The aim of this paper is to compare the relapse -free survival (RFS) and overall survival (OS) of intrahepatic lesions between these two treatment modalities.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eWe retrospectively analysed the data of patients who underwent surgery for CRLM at the First Affiliated Hospital of Xi'an Jiaotong University from 2017 to 2024 and were diagnosed with CRLM by postoperative pathology. We collected the clinicopathological characteristics of the patients in the RFA group and the patients in the PH group with or without RFA, and compared the RFS and OS of intrahepatic foci of these two treatment modalities using the log - rank test. The patients were also scored by CRS, and the differences in postoperative RFS and OS between patients with high CRS scores (\u0026ge;\u0026thinsp;3) and those with low CRS scores (\u0026lt;\u0026thinsp;3) were compared using the log - rank test. Finally, univariate analysis and multifactorial Cox regression survival analysis were performed to identify independent risk factors affecting prognosis.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eA total of 109 CRLM patients were included, 50 of whom underwent RFA and 59 underwent PH. The RFS of the RFA Group (median RFS: 14 months) was significantly shorter than that of the PH group (median RFS: 23 months) (P\u0026thinsp;=\u0026thinsp;0.013). While there was no significant difference in OS between the two groups (RFA Group median OS: undefined, PH group median OS: 62 months) (P\u0026thinsp;=\u0026thinsp;0.109). The RFS of the CRS high - scoring group (median RFS: 13 months) was slightly shorter than that of the CRS low - score group (median RFS: 17 months) (P\u0026thinsp;=\u0026thinsp;0.349), and there was no significant difference. The median OS of the CRS high - score group vs the CRS low - score group was undefined (P: 0.711), and there was no significant difference between the two groups. For RFS, the independent factors were surgical method and CEA. For OS, there were no independent factors.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eThe RFS and the OS of the PH group \u003cem\u003evs\u003c/em\u003e the RFA Group suggested that the patients with PH with or without RFA for CRLM may have better short - term control than the RFA group. The RFS and the OS of the CRS high - score group \u003cem\u003evs\u003c/em\u003e the CRS low - score group suggested that the CRS score might not accurately predict the RFS and the OS of CRLM patients after PH or RFA.\u003c/p\u003e","manuscriptTitle":"Radiofrequency ablation versus partial hepatectomy with or without radiofrequency ablation for colorectal cancer liver metastases","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-10 09:55:51","doi":"10.21203/rs.3.rs-7703592/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e852a220-fc08-4a66-a80d-f3e5d92b2f09","owner":[],"postedDate":"December 10th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-12-30T06:24:47+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-10 09:55:51","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7703592","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7703592","identity":"rs-7703592","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}