Department of Urology, Academic Medical Center University of Amsterdam, Amsterdam, The Netherlands.
BJU Int. 2011 Aug;108(4):577-82. doi: 10.1111/j.1464-410X.2010.09807.x. Epub 2010 Nov 2.
Study Type - Therapy (case series).
To present the functional and oncological mid-term results of laparoscopic cryoablation of renal masses using third generation ultrathin (17-gauge[G]) cryoprobes.
• Consecutive patients with small renal masses treated by cryoablation from September 2003 to September 2008 were prospectively evaluated. The cryoablation was performed using multiple third generation 17-G cryoprobes after intraoperative mass biopsy. • Data on serum creatinine measurements and cross sectional imaging (computed tomography/magnetic resonance imaging) were regularly collected according to a previously determined protocol. Follow-up was censored in October 2009. • Renal function analysis was based on estimated glomerular filtration rate (eGFR) at 1 year compared with baseline. Residual (or persistent tumour) and recurrence were defined as the presence of residual enhancement at first follow-up and 'de novo' enhancement of a non-enhancing cryolesion at any time during follow-up. • Survival data were analysed using the Kaplan-Meier method. Best estimates for the overall survival (OS), recurrence-free survival (RFS), cancer-specific survival (CSS) and metastatic-free survival (MFS) were made for patients with renal cell carcinoma (RCC) and for patients with RCC or non-diagnostic biopsy.
• A total of 92 patients (100 tumours; mean size 2.5 ± 0.8 cm) were treated in 95 sessions. The mean follow-up was 30.2 ± 16.6 months (Mean values are ±SD). • Intraoperative biopsy showed RCC in 51 patients (53.7%), benign lesion in 23 patients (24.2%) and was non-diagnostic in 21 patients (22.1%). Three tumour persistences and four radiological recurrences were detected. • The estimated mean RFS time and 3-year OS and RFS in patients with RCC exclusively were 47.8 (95% confidence interval [CI]: 44.1-51.1) months, 86.1% (95% CI: 71.2-93.6) and 91.8% (95% CI: 76.3-97.3), respectively. The figures were slightly higher in the group of patients with RCC or unknown pathology. The actual CSS and MFS rates were 100%. • Renal function was preserved in 84.5% of patients with normal preoperative eGFR. • Baseline eGFR was the only predictor of renal insufficiency development at 1-year follow-up.
Laparoscopic cryoablation with multiple ultrathin cryoprobes is oncologically and functionally effective at mid-term follow-up.
研究类型-治疗（病例系列）。
4。
肾肿瘤的腹腔镜冷冻消融术在短期随访中有较低的持续性和复发率，尽管高于部分肾切除术。但长期结果报道甚少。然而，它是一种适合高危患者的保肾技术。
（1）根据原发性病理（RCC、良性肿块或未确定的活检）对肾肿瘤的腹腔镜冷冻消融术的中期肿瘤学结果进行分层；（2）提供了截至随访 1 年的肾功能演变数据，证实了腹腔镜冷冻消融术后（中度）肾功能不全发展的唯一预测因素是基线时的 eGFR。
介绍使用第三代超细（17 号）冷冻探针进行肾肿瘤腹腔镜冷冻消融的功能和中期肿瘤学结果。
前瞻性评估 2003 年 9 月至 2008 年 9 月期间接受冷冻消融治疗的小肾肿块患者。在术中进行肿块活检后，使用多个第三代 17-G 冷冻探针进行冷冻消融。根据先前确定的方案，定期收集血清肌酐测量值和横断面成像（计算机断层扫描/磁共振成像）的数据。随访截止于 2009 年 10 月。肾功能分析基于与基线相比，1 年时的估计肾小球滤过率（eGFR）。残余（或持续性肿瘤）和复发定义为首次随访时出现残留增强，以及在随访期间任何时间出现非增强冷冻病变的“新发”增强。生存数据使用 Kaplan-Meier 方法进行分析。对患有肾细胞癌（RCC）的患者和患有 RCC 或非诊断性活检的患者进行了总体生存（OS）、无复发生存（RFS）、癌症特异性生存（CSS）和无转移生存（MFS）的最佳估计。
共对 92 例患者（100 个肿瘤；平均大小 2.5±0.8cm）进行了 95 次治疗。平均随访时间为 30.2±16.6 个月（平均值±标准差）。术中活检显示 RCC 51 例（53.7%），良性病变 23 例（24.2%），非诊断性病变 21 例（22.1%）。检测到 3 例肿瘤持续性和 4 例影像学复发。
仅患有 RCC 的患者的中位 RFS 时间和 3 年 OS 和 RFS 分别为 47.8（95%置信区间[CI]：44.1-51.1）个月、86.1%（95% CI：71.2-93.6）和 91.8%（95% CI：76.3-97.3）。RCC 或未知病理患者的这两个数据略高。实际的 CSS 和 MFS 率为 100%。
术前 eGFR 正常的患者中，84.5%的患者肾功能得到保留。
基线 eGFR 是 1 年随访时肾功能不全发展的唯一预测因素。
腹腔镜冷冻消融术联合使用第三代超细冷冻探针在中期随访中具有肿瘤学和功能效果。
