Department of Oncology, University of Turin, Regione Gonzole 10, 10043, Orbassano, TO, Italy,
Cardiovasc Intervent Radiol. 2014 Oct;37(5):1292-8. doi: 10.1007/s00270-013-0812-y. Epub 2013 Dec 13.
To evaluate the long-term effects of radiofrequency ablation (RFA) of renal masses (RM) and compare them with surgery.
A total of 203 RM (193 malignant; mean size 30 mm) in 137 patients (95 male subjects; average age 64 years) underwent RFA. Complications and technique effectiveness were evaluated. Overall survival, cancer-specific survival, and disease-free survival were calculated (mean follow-up time 39 months). Predictors for complications, technique effectiveness, and survival were investigated.
Seventeen (8.4 %) adverse events were recorded (2 % major complications). Exophytic development and smaller size were protective against adverse events. Complete ablation was obtained in 87 % RM (93 % ≤3 cm, 89 % ≤4 cm). T1a threshold was a positive predictor for complete ablation and central location a negative one. Three- and 5-year overall survival were 84 and 75 %; cancer-specific survival 96 and 91 %; and disease-free survival 80 and 75 %. Considering only the 79 patients with newly diagnosed renal cell carcinoma, T1a disease stage resulted a positive predictor for both overall survival (87 and 83 % at 3 and 5 years) and cancer-specific survival (100 % at 5 years).
RFA of noncentral small RM is safe and effective, and it provides favorable long-term oncological outcomes. Selection criteria for RFA can also include T1a renal cell carcinoma in patients without surgical contraindications, even though randomized controlled trials are needed to establish the best treatment.
评估射频消融（RFA）治疗肾脏肿块（RM）的长期效果，并与手术进行比较。
对 137 例患者的 203 个 RM（193 个恶性肿瘤；平均大小 30mm）进行了 RFA。评估了并发症和技术效果。计算了总生存率、癌症特异性生存率和无病生存率（平均随访时间 39 个月）。研究了并发症、技术效果和生存率的预测因素。
记录了 17 例（8.4%）不良事件（2%为严重并发症）。外生性生长和较小的肿瘤大小是预防不良事件的保护因素。87%的 RM 获得了完全消融（93%≤3cm，89%≤4cm）。T1a 阈值是完全消融的阳性预测因素，而中央位置是阴性预测因素。3 年和 5 年的总生存率分别为 84%和 75%；癌症特异性生存率分别为 96%和 91%；无病生存率分别为 80%和 75%。仅考虑 79 例新诊断为肾细胞癌的患者，T1a 疾病分期是总生存率（3 年和 5 年分别为 87%和 83%）和癌症特异性生存率（5 年时为 100%）的阳性预测因素。
非中央小 RM 的 RFA 是安全有效的，可提供良好的长期肿瘤学结果。对于没有手术禁忌症的患者，也可以选择包括 T1a 期肾细胞癌作为 RFA 的适应证，尽管需要随机对照试验来确定最佳治疗方法。
