Upfront Ablation Before Systemic Therapy Boosts Survival in Colorectal Liver Oligometastases: Nationwide Chinese Cohort

Upfront microwave ablation then adjuvant systemic therapy improved median progression-free survival vs delayed ablation (1.48 vs 0.98 years; HR 0.70, 95% CI 0.61-0.81) and overall survival (6.94 vs 4.74 years; HR 0.70, 95% CI 0.57-0.87) in a multicenter observational cohort of 1…

• Multicenter observational cohort (21 Chinese hospitals, 2009-2024) of 1,047 patients with ≤5 colorectal liver metastases <5 cm, treated with upfront or delayed microwave ablation plus systemic therapy.
• Benefit of upfront ablation persisted in key subgroups: synchronous metastases (HR 0.67, 95% CI 0.55-0.81) and lesions <3 cm (HR 0.68, 95% CI 0.58-0.80).
• Non-randomized design; residual confounding possible despite propensity score and inverse probability weighting adjustments.

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