Association of preablation tumor biopsy and long-term outcomes of colorectal liver oligometastases.

Objective: To explore the association of preablation liver biopsy and long-term oncological outcomes in colorectal liver oligometastases (CLOM) (lesions, ≤5; diameter, <5cm).

Materials And Methods: This retrospective study included 149 patients who underwent percutaneous liver biopsy before microwave ablation and 259 patients who did not receive preablation biopsy between September 2009 and June 2023 from two tertiary hospitals. Primary outcome, intrahepatic recurrence-free survival (IRFS), and secondary outcomes, disease-free survival (DFS) and overall survival (OS) were analyzed using Cox regression and Kaplan-Meier methods. Propensity score matching (PSM) and four sensitivity analyses were performed to mitigate confounding. Multivariable analyses and adjusted subgroup analyses were performed to assess the correlation of intrahepatic recurrence with preablation biopsy.

Results: 408 patients were analyzed, with 149 patients (mean age, 58 years ± 10, 105 men [70.5 %]) in the biopsy group and 259 patients (mean age, 58 years ±± 11, 186 men [71.8 %]) in the non-biopsy group. There were no statistically significant differences for 5-years IRFS (HR = 1.14 [95 % CI: 0.82-1.58]; P = 0.450), 5-years DFS (HR = 1.23 [95 % CI: 0.93-1.62]; P = 0.147), and 5-years OS (HR = 1.45 [95 % CI 0.97-2.16]; P = 0.071) between groups after PSM (n = 100). The above results were consistent with those before PSM and four sensitivity analyses. For IRFS, multivariable analyses identified that preablation liver biopsy was not an independent risk factor and did not increase the risk of intrahepatic recurrence in any subgroup based on adjusted subgroup analyses.

Conclusion: Preablation liver biopsy has no significant adverse effects on intrahepatic recurrence, disease progression, or patient survival in colorectal liver oligometastases, regardless of covariate adjustments. Our study provides evidence-based guidelines for the diagnosis and management of CLOM; liver biopsy should not be banned without consideration in the era of precision medicine.