射频消融与根治性肾切除术治疗 T1b 期肾癌的临床疗效比较。
Radiofrequency ablation versus radical nephrectomy: clinical outcomes for stage T1b renal cell carcinoma.
机构信息
From the Departments of Radiology (H.T., A.N., J.U., M.F., T.Y., T.H., H.S., K.Y.) and Nephro-Urologic Surgery and Andrology (H.K., K.A., Y.S.), Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan; and Division of Urology, Aichi Cancer Center Hospital, Nagoya, Aichi, Japan (N.S.).
出版信息
Radiology. 2014 Jan;270(1):292-9. doi: 10.1148/radiol.13130221. Epub 2013 Oct 28.
PURPOSE
To compare clinical outcomes of radiofrequency (RF) ablation retrospectively with those after radical nephrectomy in patients with stage T1b renal cell carcinoma (RCC).
MATERIALS AND METHODS
This retrospective study was approved by the institutional review board, and the requirement to obtain written informed consent was waived. From June 2002 to March 2012, 60 patients (mean age, 65.2 years; age range, 39-86 years) with a single RCC measuring 4.1-7.0 cm (stage T1b) underwent RF ablation (n = 21) or radical nephrectomy (n = 39). Selective renal artery embolization was performed before RF ablation in eight patients. The overall, RCC-related, and disease-free survival rates, the percentage decrease in the glomerular filtration rate (GFR), and safety were compared by using the log-rank (survival), paired and Student t (GFR), and Fisher exact (safety) tests.
RESULTS
The overall survival rate was significantly lower in the RF ablation group than in the radical nephrectomy group (48% vs 97% at 10 years, respectively; 95% confidence interval [CI]: 12.4%, 76.7% vs 78.2%, 99.5%; P < .009). The RCC-related survival rate (94% [95% CI: 62.6%, 99.1%] with RF ablation vs 100% with radical nephrectomy at 10 years) and the disease-free survival rate (88% [95% CI: 59.2%, 96.9%] with RF ablation vs 84% [95% CI: 60.6%, 94.3%] with radical nephrectomy at 10 years, P = .99) were comparable between the two groups. No treatment-related deaths occurred. Although major complication rates were similar between the two patient groups (8.0% [two of 25 patients] vs 5.1% [two of 39 patients], P = .61), the percentage decrease in the GFR was significantly lower in the RF ablation group than in the radical nephrectomy group at the last follow-up (12.5% ± 23.4 vs 32.3% ± 20.8, respectively; P < .003).
CONCLUSION
RF ablation is a safe procedure for patients at substantial surgical risk for radical nephrectomy, providing comparable RCC-related and disease-free survival and preserving renal function.
目的
回顾性比较射频 (RF) 消融与根治性肾切除术治疗 T1b 期肾细胞癌 (RCC) 患者的临床结果。
材料与方法
本回顾性研究获得了机构审查委员会的批准，且豁免了获取书面知情同意的要求。2002 年 6 月至 2012 年 3 月，60 例（平均年龄 65.2 岁；年龄范围 39-86 岁）单发性 RCC 直径为 4.1-7.0 cm（T1b 期）的患者接受了 RF 消融（n=21）或根治性肾切除术（n=39）治疗。8 例患者在接受 RF 消融前进行了选择性肾动脉栓塞。采用对数秩（生存）、配对和学生 t（GFR）以及 Fisher 确切概率（安全性）检验比较总生存率、RCC 相关生存率、无病生存率、肾小球滤过率（GFR）的下降百分比和安全性。
结果
RF 消融组的总生存率明显低于根治性肾切除术组（10 年时分别为 48%和 97%；95%置信区间[CI]：12.4%，76.7%vs 78.2%，99.5%；P<.009）。RCC 相关生存率（RF 消融组 10 年时为 94%[95%CI：62.6%，99.1%]，根治性肾切除术组为 100%）和无病生存率（RF 消融组 10 年时为 88%[95%CI：59.2%，96.9%]，根治性肾切除术组为 84%[95%CI：60.6%，94.3%]）在两组间相当。两组患者均无治疗相关死亡。尽管两组患者的主要并发症发生率相似（8.0%[25 例患者中的 2 例] vs 5.1%[39 例患者中的 2 例]，P=0.61），但在最后一次随访时，RF 消融组的 GFR 下降百分比明显低于根治性肾切除术组（12.5%±23.4% vs 32.3%±20.8%，P<.003）。
结论
对于接受根治性肾切除术风险较大的患者，RF 消融是一种安全的治疗方法，可提供相似的 RCC 相关生存率和无病生存率，并保留肾功能。
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