Malcolm John B, Berry Tristan T, Williams Michael B, Logan Joshua E, Given Robert W, Lance Raymond S, Barone Bethany, Shaves Sarah, Vingan Harlan, Fabrizio Michael D
Department of Urology, Eastern Virginia Medical School, Norfolk, Virginia 23510, USA.
J Endourol. 2009 Jun;23(6):907-11. doi: 10.1089/end.2008.0608.
While partial nephrectomy remains the gold standard for the management of most small renal masses, increasing experience with renal cryoablation has suggested a viable alternative with a favorable morbidity profile and good efficacy. We report intermediate-term oncologic outcomes from a single-center experience with laparoscopic and percutaneous renal cryoablation.
We performed a retrospective review of our laparoscopic renal cryoablation (LRC) and percutaneous renal cryoablation (PRC) experience between January 2003 and April 2007. Patients with at least 12 months of follow-up were included in the analysis. Follow-up consisted of imaging and laboratory studies at regular intervals. Persistent mass enhancement or interval tumor growth was considered a treatment failure.
Sixty-six patients (44% women/56% men; 42% African-American/58% Caucasian/other; mean body mass index, 29.7) with 72 tumors underwent either LRC (n = 52) or PRC (n = 20) with a mean follow-up of 30 months (median 25.1 mos; range 13-63 mos). Average patient age was 66.5 years (range 34-82 yrs). Mean tumor size was 2.33 cm (range 1-4.6 cm). Comorbid conditions were prevalent: 76% hypertension, 36% hyperlipidemia, 24% chronic kidney disease, 29% diabetes mellitus, 36% tobacco use, and 32% heart disease. RESULTS of pretreatment biopsy were 62% renal-cell carcinoma and 38% benign or nondiagnostic. Overall cancer-specific and cancer-free survival were 100% and 97%, respectively. There were two treatment failures (3.8%) in the LRC group and five primary failures in the PRC group (25%) (P = 0.015), four of which were salvaged with repeated PRC with no evidence of recurrence at 6 to 36 months of follow-up. There has been no significant local or metastatic progression.
LRC and PRC achieved good oncologic control with minimal morbidity at a mean follow-up of 30 months in a patient cohort characterized by numerous comorbid conditions. PRC had a significantly higher primary treatment failure rate than LRC, but re-treatment offered salvage oncologic control with no significant complications.
虽然部分肾切除术仍是大多数小肾肿块治疗的金标准，但肾冷冻消融经验的增加提示其是一种可行的替代方法，具有良好的发病率特征和疗效。我们报告了单中心腹腔镜和经皮肾冷冻消融的中期肿瘤学结果。
我们对2003年1月至2007年4月间腹腔镜肾冷冻消融（LRC）和经皮肾冷冻消融（PRC）的经验进行了回顾性研究。分析纳入了至少随访12个月的患者。随访包括定期的影像学和实验室检查。持续的肿块强化或肿瘤间隔期生长被视为治疗失败。
66例患者（44%为女性/56%为男性；42%为非裔美国人/58%为白种人/其他；平均体重指数为29.7），共72个肿瘤，接受了LRC（n = 52）或PRC（n = 20）治疗，平均随访时间为30个月（中位数25.1个月；范围13 - 63个月）。患者平均年龄为66.5岁（范围34 - 82岁）。平均肿瘤大小为2.33 cm（范围1 - 4.6 cm）。合并症普遍存在：76%患有高血压，36%患有高脂血症，24%患有慢性肾病，29%患有糖尿病，36%吸烟，32%患有心脏病。治疗前活检结果为62%为肾细胞癌，38%为良性或未明确诊断。总体癌症特异性生存率和无癌生存率分别为100%和97%。LRC组有2例治疗失败（3.8%），PRC组有5例初次治疗失败（25%）（P = 0.015），其中4例经重复PRC挽救治疗后，在6至36个月的随访中无复发证据。无明显的局部或远处进展。
在以多种合并症为特征的患者队列中，LRC和PRC在平均随访30个月时实现了良好的肿瘤学控制，且发病率最低。PRC的初次治疗失败率显著高于LRC，但再次治疗提供了挽救性肿瘤学控制，且无明显并发症。
