小肾肿瘤冷冻消融与微波消融的荟萃分析：结局是否存在差异？
Meta-analysis of cryoablation versus microwave ablation for small renal masses: is there a difference in outcome?
机构信息
From the Department of Radiology (J.M.), McMaster University Michael G. Degroote School of Medicine, Hamilton, Ontario, Canada; the Department of Radiology (S.A. e-mail:
出版信息
Diagn Interv Radiol. 2013 Nov-Dec;19(6):501-7. doi: 10.5152/dir.2013.13070.
PURPOSE
We aimed to compare local and metastatic recurrence of small renal masses primarily treated by cryoablation or microwave ablation.
MATERIALS AND METHODS
The MEDLINE, CINAHL, and PUBMED databases were searched to review the treatment of small renal masses with cryoablation or microwave ablation. Fifty-one studies met the inclusion criteria.
RESULTS
Fifty-one studies representing 3950 kidney lesions were analyzed. No differences were detected in the mean patient age (P = 0.150) or duration of follow-up (P = 0.070). The mean tumor size was significantly larger in the microwave ablation group compared with the cryoablation group (P = 0.030). There was no difference between microwave ablation and cryoablation groups in terms of primary effectiveness (93.75% vs. 91.27%, respectively; P = 0.400), cancer-specific survival (98.27% vs. 96.8%, respectively; P = 0.470), local tumor progression (4.07% vs. 2.53%, respectively; P = 0.460), or progression to metastatic disease (0.8% vs. 0%, respectively; P = 0.120). Patient age was predictive of overall complications in the multivariate analysis (P = 0.020). Local tumor progression with cryoablation was predicted by the mean follow-up duration using univariate (P = 0.009) and multivariate regression (P = 0.003). Clear cell and angiomyolipoma were more frequent in the microwave ablation group (P < 0.0001 and P = 0.03328, respectively), and papillary, chromophobe, and oncocytoma were more frequent in the cryoablation group (P < 0.0001, P < 0.0001, and P = 0.0004, respectively). Open access was used more often in the microwave ablation group than in the cryoablation group (12.20% vs. 1.04%, respectively; P < 0.0001), and percutaneous access was used more frequently in the cryoablation group than in the microwave ablation group (88.64% vs. 37.20%, respectively; P = 0.0021).
CONCLUSION
There is no difference in local or metastatic recurrence between cryoablation- and microwave ablation-treated small renal masses.
目的
我们旨在比较主要采用冷冻消融或微波消融治疗的小肾肿瘤的局部和远处转移复发情况。
材料和方法
检索 MEDLINE、CINAHL 和 PUBMED 数据库，以回顾冷冻消融或微波消融治疗小肾肿瘤的治疗。符合纳入标准的 51 项研究。
结果
分析了 51 项研究共 3950 个肾脏病变。两组患者的平均年龄（P=0.150）或随访时间（P=0.070）无差异。微波消融组的平均肿瘤大小明显大于冷冻消融组（P=0.030）。在主要疗效方面，微波消融组与冷冻消融组无差异（分别为 93.75%和 91.27%；P=0.400），癌症特异性生存率（分别为 98.27%和 96.8%；P=0.470），局部肿瘤进展（分别为 4.07%和 2.53%；P=0.460）或转移疾病进展（分别为 0.8%和 0%；P=0.120）。多变量分析显示，患者年龄是总体并发症的预测因素（P=0.020）。单变量（P=0.009）和多变量回归（P=0.003）预测冷冻消融后局部肿瘤进展的是平均随访时间。微波消融组中透明细胞癌和血管平滑肌脂肪瘤更为常见（P<0.0001 和 P=0.03328），冷冻消融组中乳头状癌、嫌色细胞癌和嗜酸细胞瘤更为常见（P<0.0001、P<0.0001 和 P=0.0004）。微波消融组中开放手术比例高于冷冻消融组（分别为 12.20%和 1.04%；P<0.0001），冷冻消融组中经皮手术比例高于微波消融组（分别为 88.64%和 37.20%；P=0.0021）。
结论
冷冻消融和微波消融治疗的小肾肿瘤在局部和远处转移复发方面无差异。
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