Department of Radiology,Mayo Clinic School of Medicine, Rochester, MN 55905, USA.
BJU Int. 2012 Dec;110(11 Pt B):E526-31. doi: 10.1111/j.1464-410X.2012.11230.x. Epub 2012 May 15.
What's known on the subject? and What does the study add? Percutaneous renal cryoablation is a safe and effective treatment for patients with small renal masses, who are poor surgical candidates. Oncological outcomes from previous percutaneous ablation studies are difficult to interpret because of the large number of patients treated with a history of RCC (38% in our experience) and the large number of treated renal masses without a pathology-proven diagnosis. This cryoablation study addresses these issues by evaluating only solitary, sporadic biopsy-proven RCC. Oncological outcomes and complications were also evaluated by tumour T-stage, which allows some degree of comparison with previously published surgical results.
• To evaluate retrospectively our single institution experience with percutaneous cryoablation of solitary, sporadic renal cell carcinomas (RCCs), and to compare the efficacy and safety of this technique for treatment of different T-stage RCC.
• 116 patients were treated with percutaneous cryoablation for a solitary, sporadic biopsy-proven RCC in a single treatment session between November 2003 and November 2010. • The technical success of the ablation procedure, complications and evidence for local or metastatic tumour recurrence were evaluated for each patient.
• 83 patients (72%) were treated for a stage T1a RCC, 27 patients (23%) for a stage T1b RCC, and six patients (5%) for a stage T2 RCC. • Technical success was achieved in the treatment of 115 of 116 (99%) renal tumours. The single technical failure occurred in the treatment of a 4.3-cm RCC. • Local recurrent tumour was identified in one of 88 patients (1%) with follow-up computed tomography (CT) or magnetic resonance imaging available for review >3 months from the time of ablation. The median (range) imaging follow-up in these patients was 21 (3-73) months. The local tumour recurrence was identified on CT 11 months after the ablation procedure in a patient treated for a 2.7 cm RCC. • None of the patients developed metastatic RCC. • The major complication rate was 4% for patients with stage T1a tumours, 15% for those with stage T1b tumours, and 33% for those with stage T2 tumours. There were no procedural-related deaths.
• Percutaneous renal cryoablation of RCC can be performed with high technical success in patients with tumours up to, and beyond 7 cm in maximum diameter. • The tumour recurrence rate after percutaneous renal cryoablation was low, and recurrence was not related to tumour size in this group of patients. • Statistically significant higher complication rates were seen with treatment of larger (higher T-stage) RCCs.
• 回顾性评估我们机构对单个、散发性肾细胞癌（RCC）进行经皮冷冻消融的经验，并比较该技术治疗不同 T 期 RCC 的疗效和安全性。
• 2003 年 11 月至 2010 年 11 月期间，在单次治疗中，对 116 例单个、散发性活检证实的 RCC 患者进行了经皮冷冻消融治疗。• 评估每位患者的消融手术技术成功率、并发症以及局部或转移性肿瘤复发的证据。
• 83 例（72%）患者因 T1a 期 RCC 接受治疗，27 例（23%）患者因 T1b 期 RCC 接受治疗，6 例（5%）患者因 T2 期 RCC 接受治疗。• 116 例肾脏肿瘤中有 115 例（99%）治疗技术成功。唯一的技术失败发生在治疗 4.3cm RCC 时。• 在有 3 个月以上消融后 CT 或磁共振成像（MRI）随访资料可查的 88 例患者中，发现 1 例（1%）局部复发性肿瘤。这些患者的中位（范围）影像学随访时间为 21（3-73）个月。在一名治疗 2.7cm RCC 的患者中，消融后 11 个月 CT 发现局部肿瘤复发。• 无患者发生转移性 RCC。• T1a 期肿瘤患者的主要并发症发生率为 4%，T1b 期肿瘤患者为 15%，T2 期肿瘤患者为 33%。无与操作相关的死亡。
• 经皮肾冷冻消融术可在最大直径达 7cm 及以上的肿瘤患者中安全有效地进行。• 经皮肾冷冻消融术后肿瘤复发率低，且在该组患者中与肿瘤大小无关。• 治疗较大（较高 T 期）RCC 时，并发症发生率显著升高。
