Survival outcomes and quality of life after percutaneous cryoablation for liver metastasis: A systematic review and meta-analysis

PLOS ONE RESEARCH ARTICLE Survival outcomes and quality of life after percutaneous cryoablation for liver metastasis: A systematic review and metaanalysis Shaghayegh Khanmohammadi1,2,3☯, Amir Hossein Behnoush1,2,3☯, Shahram Akhlaghpoor ID4* a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 1 Research Center for Immunodeficiencies, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran, 2 Endocrinology and Metabolism Population Sciences Institute, Non-Communicable Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran, 3 School of Medicine, Tehran University of Medical Sciences, Tehran, Iran, 4 Department of Radiology, Pardis Noor Medical Imaging Center, Tehran, Iran ☯ These authors contributed equally to this work. * Abstract OPEN ACCESS Citation: Khanmohammadi S, Behnoush AH, Akhlaghpoor S (2023) Survival outcomes and quality of life after percutaneous cryoablation for liver metastasis: A systematic review and metaanalysis. PLoS ONE 18(8): e0289975. https://doi. org/10.1371/journal.pone.0289975 Background Liver metastasis is present in a wide range of malignancies, with colorectal cancer as the most common site. Several minimally invasive treatments have been suggested for managing hepatic metastases, and cryoablation is among them, yet not widely used. In this systematic review, we aimed to assess the effectiveness of percutaneous cryoablation in all types of liver metastases. Editor: Ezio Lanza, Humanitas Clinical and Research Center - IRRCS, ITALY Received: March 28, 2023 Accepted: July 29, 2023 Published: August 16, 2023 Copyright: © 2023 Khanmohammadi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: All relevant data are within the paper and its Supporting information files. Funding: The author(s) received no specific funding for this work. Competing interests: The authors have declared that no competing interests exist. Methods A systematic search was performed in international databases, including PubMed, Scopus, Embase, and Web of Science, to find relevant studies reporting outcomes for percutaneous cryoablation in liver metastasis patients. In addition to baseline features such as mean age, gender, metastasis origin, and procedure details, procedure outcomes, including overall survival, local recurrence, quality of life (QoL), and complications, were extracted from the studies. Random-effect meta-analysis was performed to calculate the mean difference (MD) and 95% confidence interval for comparison of QoL. Results We screened 2131 articles. Fifteen studies on 692 patients were included. Mean overall survival ranged from 14.5–29 months. The rate of local recurrence in the included studies ranged from 9.4% to 78%, and local control progression-free survival ranged from 1 to 31 months. The total QoL decreased one week after the cryoablation procedure (-3.08 [95% Confidence interval: -4.65, -1.50], p-value <0.01) but increased one month (5.69 [3.99, PLOS ONE | https://doi.org/10.1371/journal.pone.0289975 August 16, 2023 1 / 17 PLOS ONE Percutaneous cryoablation for liver metastasis 7.39], p-value <0.01) and three months (3.75 [2.25, 5.24], p-value <0.01) after the procedure. Conclusion Cryoablation is an effective procedure for the treatment of liver metastases, especially in cases that are poor candidates for liver resection. It could significantly improve QoL with favorable local recurrence. 1. Introduction The liver is a common site for metastasis from various malignancies such as colorectal cancer, lung cancer, melanoma, and breast cancer, among which colorectal cancer is the most common primary site [1]. In the United States, about 5.1% of all patients diagnosed with malignancy have synchronous liver metastases at the time of diagnosis [2], while it reaches 50% in patients with colorectal cancer origin [3]. Several clinical modalities have been established for liver metastases treatment, including liver resection, systemic and local chemotherapy, and radiotherapy [4]. While liver resection is still the main curative option for colorectal liver metastases [5], this is not the case for many others, such as breast cancer and esophageal cancer [6,7]. In recent years, interventional oncology has become very popular for managing primary and secondary liver malignancies due to its ability to improve survival, reduce tumor burden, and low complication rate [8]. So, the emerging role of interventional oncology as a treatment alone, as a bridge to transplantation, or in association with other approaches could not be denied [9,10]. Thermal ablation, including radiofrequency ablation (RFA) or microwave ablation (MWA), is the most popular local minimally invasive method with many publications and studies. However, cold ablation is less considered in the liver and is not extensively available. Percutaneous cryoablation is in situ destruction of tumor cells with low temperatures. Mechanistically, cellular dehydration, protein denaturation, and microcirculatory failure in thawing and freezing cycles are the main pathways the cryoablation affects the tumor [11]. The current method of cryoablation is the administration of probes with the use of circulating cooled fluid or gas, such as nitrogen or argon, which then expands into a gas, creating low temperatures, including the Joule-Thomson effect [12]. It was first suggested that cryoablation might only be used in cases of liver metastases from colorectal cancer; however, several other studies have assessed the procedure’s effects in other types of metastases [13–15]. Many of these studies have shown the efficacy of cryoablation in improving survival and quality of life (QoL). To date, there is no systematic review investigating the role of cryoablation in liver metastases from different origins. In the present systematic review, we aimed to investigate the effectiveness of percutaneous cryoablation in treating liver metastases through a systematic search in the literature and finding relevant studies. 2. Methods and materials This review was conducted in compliance with the review protocol registered on PROSPERO, 2023 CRD42023390082. The Preferred Reporting Items for Systematic Reviews and MetaAnalyses (PRISMA) Statement was followed in this study [16]. An ethics statement is not applicable because this study is based exclusively on published literature. PLOS ONE | https://doi.org/10.1371/journal.pone.0289975 August 16, 2023 2 / 17 PLOS ONE Percutaneous cryoablation for liver metastasis 2.1. Literature search We systematically searched the electronic databases PubMed, Web of Science (ISI), SCOPUS, and Embase for original articles from inception to November 15, 2022. We created our search strategy in PubMed and subsequently sear (...truncated)