Department of Urology, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio 44106-5046, USA.
Urology. 2011 Mar;77(3):649-54. doi: 10.1016/j.urology.2010.08.016. Epub 2010 Dec 24.
To evaluate whether the trend in patient selection or perioperative parameters were associated with treatment outcomes after percutaneous cryoablation (PCA) of renal masses.
We retrospectively analyzed our urological oncology database and identified 52 patients treated for a total of 54 renal masses. Univariate analysis was performed to evaluate whether the variables of age, gender, tumor size, number of probes used, total freezing time, preoperative creatinine, American Society of Anesthesia class, body mass index, or age-adjusted Charlson comorbidity index (CCI) score had an impact on the outcomes of treatment failure or the complication rate.
During a mean follow-up of 21 months, recurrence-free, overall, and disease-specific (based on radiographic follow-up and biopsy) survival were 96.2%, 98.1% and 100%, respectively. The mean age-adjusted CCI score for patients with postoperative complications was 6.5, compared with a mean score of 3.0 in patients without postoperative complications (P = .02). The complication rate was also significantly higher when a greater number of cryoprobes were used during PCA (P < .005). None of the variables analyzed were predictive of treatment failure.
Of the pre- and intraoperative variables studied, age-adjusted CCI score and number of cryoprobes used were the only variables with predictive value for outcomes in regard to treatment failure or complications. As investigators continue using cryoablation to treat renal masses, it is important to be able to completely and honestly counsel patients regarding the likelihood of complications and need for subsequent therapy in the setting of treatment failure.
评估患者选择或围手术期参数的趋势是否与肾肿瘤经皮冷冻消融（PCA）治疗后的结果相关。
我们回顾性分析了我们的泌尿外科肿瘤数据库，共纳入 52 例接受 54 个肾肿瘤治疗的患者。进行单因素分析，以评估年龄、性别、肿瘤大小、使用的探针数量、总冷冻时间、术前肌酐、美国麻醉医师协会（ASA）分级、体重指数或年龄调整Charlson 合并症指数（CCI）评分等变量是否对治疗失败或并发症发生率的结果有影响。
在平均 21 个月的随访期间，无复发生存率、总生存率和疾病特异性生存率（基于影像学随访和活检）分别为 96.2%、98.1%和 100%。术后发生并发症的患者的平均年龄调整 CCI 评分为 6.5，而无术后并发症的患者的平均评分则为 3.0（P=0.02）。在 PCA 中使用更多的冷冻探针时，并发症发生率也显著更高（P<0.005）。分析的所有变量均不能预测治疗失败。
在所研究的术前和术中变量中，年龄调整 CCI 评分和使用的冷冻探针数量是唯一与治疗失败或并发症结果有预测价值的变量。随着研究人员继续使用冷冻消融治疗肾肿瘤，能够全面、诚实地向患者提供关于并发症发生的可能性以及在治疗失败时需要后续治疗的可能性的咨询非常重要。
