Division of Urology, Washington University School of Medicine, Saint Louis, MO.
Department of Radiology, Washington University School of Medicine, Saint Louis, MO.
Urology. 2014 May;83(5):1081-7. doi: 10.1016/j.urology.2013.10.081. Epub 2014 Feb 21.
To compare perioperative and oncologic outcomes between laparoscopic (LCA) and percutaneous cryoablation (PCA) and identify predictors of treatment failure after cryoablation.
Retrospective analysis was performed on 145 patients undergoing LCA and 118 patients undergoing PCA at our institution between July 2000 and June 2011.
LCA and PCA were performed on 167 and 123 tumors, respectively. Perioperative complication rates were 10% for both the groups. Mean length of stay was significantly shorter for the PCA group (2.1 ± 0.5 vs 3.5 ± 3.1 days, P <.01). Both groups had a comparable decline in estimated glomerular filtration rate at most recent follow-up (LCA 3.8 ± 18.5 mL/min/1.73 m(2) vs PCA 6.6 ± 17.1 mL/min/1.73 m(2), P = .21). Mean oncologic follow-up was 71.4 ± 32.1 months for LCA and 38.6 ± 19.6 months for PCA. Kaplan-Meier estimated 5-year overall and recurrence-free survival were 79.3% and 85.5%, respectively, for LCA and 86.3% and 86.3%, respectively, for PCA. Multivariate Cox proportional hazards analysis demonstrated that cryoablation approach (LCA vs PCA) was not predictive of overall mortality or disease recurrence (P = .36 and .82, respectively). Predictors of overall mortality included age-adjusted Charlson comorbidity index ≥ 6 (P = .01) and preoperative estimated glomerular filtration rate <60 mL/min/1.73 m(2) (P = .02). Predictors of recurrence included tumor size ≥ 3 cm (P <.01), body mass index ≥ 30 kg/m(2) (P = .01), and endophytic growth (P = .04).
Mean length of stay was shorter for patients undergoing PCA as compared with LCA. Complication rates and decline in renal function at most recent follow-up were similar between groups. Oncologic outcomes were influenced by baseline patient and tumor characteristics rather than the cryoablation approach.
比较腹腔镜（LCA）和经皮冷冻消融（PCA）的围手术期和肿瘤学结果，并确定冷冻消融后治疗失败的预测因素。
对 2000 年 7 月至 2011 年 6 月期间在我院接受 LCA 和 PCA 的 145 例患者和 118 例患者进行回顾性分析。
LCA 和 PCA 分别用于 167 个和 123 个肿瘤。两组的围手术期并发症发生率均为 10%。PCA 组的平均住院时间明显更短（2.1 ± 0.5 天 vs 3.5 ± 3.1 天，P <.01）。两组在最近一次随访时估算肾小球滤过率均有可比的下降（LCA 3.8 ± 18.5 mL/min/1.73 m2 与 PCA 6.6 ± 17.1 mL/min/1.73 m2，P =.21）。LCA 的平均肿瘤随访时间为 71.4 ± 32.1 个月，PCA 为 38.6 ± 19.6 个月。Kaplan-Meier 估计的 5 年总生存率和无复发生存率分别为 LCA 的 79.3%和 85.5%，PCA 的 86.3%和 86.3%。多变量 Cox 比例风险分析表明，冷冻消融方法（LCA 与 PCA）与总死亡率或疾病复发均无相关性（P =.36 和.82）。总死亡率的预测因素包括年龄调整 Charlson 合并症指数≥6（P =.01）和术前估算肾小球滤过率<60 mL/min/1.73 m2（P =.02）。复发的预测因素包括肿瘤大小≥3 cm（P <.01）、体重指数≥30 kg/m2（P =.01）和内生性生长（P =.04）。
与 LCA 相比，接受 PCA 的患者平均住院时间较短。两组的并发症发生率和最近一次随访时肾功能下降情况相似。肿瘤学结果受基线患者和肿瘤特征的影响，而不是冷冻消融方法。
