Stern Joshua M, Svatek Robert, Park Sangtae, Hermann Michael, Lotan Yair, Sagalowsky Arthur I, Cadeddu Jeffrey A
Department of Urology, University of Texas, Southwestern Medical Center, Dallas, TX 75390-9110, USA.
BJU Int. 2007 Aug;100(2):287-90. doi: 10.1111/j.1464-410X.2007.06937.x.
To compare the intermediate-term outcomes of patients with clinical T1a renal tumours who were treated with nephron-sparing surgery by partial nephrectomy (PN), the preferred approach for small (cT1a) renal tumours, or radiofrequency ablation (RFA), recently offered to selected patients as an alternative, less morbid technique.
We identified patients with stage T1a renal masses who had > or = 2 years of follow-up; those with bilateral synchronous or metachronous tumours, metastatic disease at presentation, or a family history of renal cell carcinoma were excluded. From July 1996 to January 2004 110 PNs were identified in our database; 37 patients who fulfilled the inclusion criteria had either open (30) or laparoscopic PN (seven) and 40 had either percutaneous (26) or laparoscopic (14) RFA.
The mean (range) follow-up for the RFA and PN groups was 30 (18-42) and 47 (24-93) months, respectively; the respective mean tumour size was 2.41 and 2.43 cm. There was one incomplete ablation and two local recurrences in the RFA group, and two recurrences in the PN group (one local and one in the contralateral kidney). There were no disease-specific deaths. The overall actuarial disease-free probability for the PN and RFA groups, respectively, was 95.8% and 93.4% (P = 0.67).
This initial 3-year actuarial analysis showed that RFA for cT1a renal tumours has comparable oncological outcomes to PN; however, longer term data are still needed.
比较接受保留肾单位手术的临床T1a期肾肿瘤患者的中期预后情况，保留肾单位手术采用肾部分切除术（PN），这是小（cT1a）肾肿瘤的首选方法，或射频消融术（RFA），最近作为一种替代的、创伤较小的技术应用于部分患者。
我们确定了T1a期肾肿块且随访时间≥2年的患者；排除双侧同时性或异时性肿瘤、就诊时存在转移性疾病或有肾细胞癌家族史的患者。1996年7月至2004年1月，在我们的数据库中识别出110例接受肾部分切除术的患者；37例符合纳入标准的患者接受了开放性（30例）或腹腔镜肾部分切除术（7例），40例接受了经皮（26例）或腹腔镜（14例）射频消融术。
射频消融术组和肾部分切除术组的平均（范围）随访时间分别为30（18 - 42）个月和47（24 - 93）个月；各自的平均肿瘤大小为2.41 cm和2.43 cm。射频消融术组有1例消融不完全和2例局部复发，肾部分切除术组有2例复发（1例局部复发，1例对侧肾复发）。无疾病特异性死亡。肾部分切除术组和射频消融术组的总体无病生存率分别为95.8%和93.4%（P = 0.67）。
这项初步的3年精算分析表明，cT1a期肾肿瘤的射频消融术与肾部分切除术具有相当的肿瘤学预后；然而，仍需要长期数据。
