Kunkle David A, Uzzo Robert G
Department of Urologic Oncology, Fox Chase Cancer Center, Temple University School of Medicine, Philadelphia, Pennsylvania, USA.
Cancer. 2008 Nov 15;113(10):2671-80. doi: 10.1002/cncr.23896.
The incidence of renal cell carcinoma is rising because of incidental detection of small renal masses (SRMs). Although surgical resection remains the standard of care, cryoablation and radiofrequency ablation (RFA) have emerged as minimally invasive treatment alternatives. The authors of this report performed a comparative meta-analysis evaluating cryoablation and RFA as primary treatment for SRMs.
A search of the MEDLINE database was performed reviewing the world literature for clinically localized renal masses treated by cryoablation or RFA.
Forty-seven studies representing 1375 kidney lesions treated by cryoablation or RFA were analyzed. No differences were detected between ablation modalities with regard to mean patient age (P = .17), tumor size (P = .12), or duration of follow-up (P = .53). Pretreatment biopsy was performed more often for cryoablated lesions (82.3%) than for RFA (62.2%; P < .0001). Unknown pathology occurred at a significantly higher rate for SRMs that underwent RFA (40.4%) versus cryoablation (24.5%; P < .0001). Repeat ablation was performed more often after RFA (8.5% vs 1.3%; P < .0001), and the rates of local tumor progression were significantly higher for RFA (12.9% vs 5.2%; P < .0001) compared with cryoablation. The higher incidence of local tumor progression was found to be correlated significantly with treatment by RFA on univariate analysis (P = .001) and on multivariate regression analysis (P = .003). Metastasis was reported less frequently for cryoablation (1.0%) versus RFA (2.5%; P = .06). Cryoablation usually was performed laparoscopically (65%), whereas 94% of lesions that were treated with RFA were approached percutaneously.
Ablation of SRMs is a viable strategy based on short-term oncologic outcomes. Although extended oncologic efficacy remains to be established for ablation modalities, the current data suggest that cryoablation results in fewer retreatments and improved local tumor control, and it may be associated with a lower risk of metastatic progression compared with RFA.
由于小肾肿块（SRMs）的偶然发现，肾细胞癌的发病率正在上升。尽管手术切除仍然是标准的治疗方法，但冷冻消融和射频消融（RFA）已成为微创治疗的替代方法。本报告的作者进行了一项比较性荟萃分析，评估冷冻消融和RFA作为SRMs的主要治疗方法。
检索MEDLINE数据库，回顾世界范围内关于通过冷冻消融或RFA治疗临床局限性肾肿块的文献。
分析了47项研究，共1375个通过冷冻消融或RFA治疗的肾脏病变。在消融方式之间，患者平均年龄（P = 0.17）、肿瘤大小（P = 0.12）或随访时间（P = 0.53）方面未发现差异。冷冻消融病变（82.3%）比RFA（62.2%；P < 0.0001）更常进行术前活检。接受RFA的SRMs（40.4%）与冷冻消融（24.5%；P < 0.0001）相比，未知病理发生率显著更高。RFA后更常进行重复消融（8.5%对1.3%；P < 0.0001），与冷冻消融相比，RFA的局部肿瘤进展率显著更高（12.9%对5.2%；P < 0.0001）。在单因素分析（P = 0.001）和多因素回归分析（P = 0.003）中，发现局部肿瘤进展的较高发生率与RFA治疗显著相关。冷冻消融的转移报告频率低于RFA（1.0%对2.5%；P = 0.06）。冷冻消融通常通过腹腔镜进行（65%），而接受RFA治疗的病变94%是经皮进行的。
基于短期肿瘤学结果，消融SRMs是一种可行的策略。尽管消融方式的长期肿瘤学疗效仍有待确定，但目前的数据表明，与RFA相比，冷冻消融导致的再次治疗更少，局部肿瘤控制更好，并且可能与转移进展风险较低相关。
