Forauer Andrew R, Dewey Benjamin J, Seigne John D
Division of Interventional Radiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
Geisel School of Medicine at Dartmouth College, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
Urol Oncol. 2014 Aug;32(6):869-76. doi: 10.1016/j.urolonc.2014.03.016. Epub 2014 Jun 16.
There are numerous reports describing the use of radiofrequency ablation (RFA) to treat renal cell carcinoma. Many series, however, describe heterogeneous populations, lack histologic descriptions, use various RFA systems, and indicate tumor destruction by different ablation end points. This study examined the outcomes of computed tomography-guided, impedance-based RFA of biopsy-proven renal cell carcinoma clinically staged as T1a with a minimum of 1 year of postablation follow-up.
This retrospective study identified all consecutive patients who had undergone renal RFA since May 2005 at our institution. Patients without biopsy-proven renal cell carcinoma (RCCa) were excluded. Of the patients who met these criteria, evaluation was limited to patients with a minimum of 12 months of follow-up. Data collected from the patients' electronic medical and radiologic records included demographic data, tumor-related data, procedural details, and clinical follow-up visits.
A total of 39 patients (46 lesions) met the inclusion criteria. The mean tumor diameter was 2.6 cm (range: 1.2-4.0 cm). The most common histologies were clear cell (n = 27) and papillary (n = 16) renal cancer. The lesion location was equally divided between upper pole (n = 16), middle pole (n = 16), and lower pole (n = 14). Overall, 83% of the tumors were exophytic. No residual or recurrent enhancing mass was identified in the ablation bed on post-RFA imaging during the mean follow-up period of 35.3 months (range: 12-83). All patients were treated in a single encounter and no lesion required a second ablation; technical success (absence of residual tumor) on the initial post-RFA imaging study was 46 of 46 (100%). Clinical success was achieved in 45 of 46 lesions (98%); residual, viable tumor was found in a pretransplant nephrectomy specimen on postprocedure day 127. The mean cancer-free survival was 36.2 months. Comparison of preablation and postablation renal function found no statistically significant change.
The consistent outcomes in our post-RFA imaging and clinical surveillance allow us to offer image-guided ablation to patients with T1a RCCa as a valid treatment option offering long-term cancer-free survival. Impedance-based RFA in a carefully selected patient population with T1a RCCa is a reliable treatment option, with disease-free survival rates that are comparable to partial nephrectomy.
有大量报告描述了使用射频消融（RFA）治疗肾细胞癌。然而，许多系列研究描述的人群异质性较大，缺乏组织学描述，使用了各种RFA系统，并以不同的消融终点来指示肿瘤破坏情况。本研究考察了经计算机断层扫描引导、基于阻抗的RFA治疗经活检证实为临床分期T1a的肾细胞癌的结果，并进行了至少1年的消融后随访。
这项回顾性研究纳入了自2005年5月以来在本机构接受肾脏RFA的所有连续患者。未经过活检证实为肾细胞癌（RCCa）的患者被排除。在符合这些标准的患者中，评估仅限于随访至少12个月的患者。从患者的电子病历和放射学记录中收集的数据包括人口统计学数据、肿瘤相关数据、手术细节以及临床随访情况。
共有39例患者（46个病灶）符合纳入标准。肿瘤平均直径为2.6 cm（范围：1.2 - 4.0 cm）。最常见的组织学类型为透明细胞癌（n = 27）和乳头状癌（n = 16）。病灶位于上极（n = 16）、中极（n = 16）和下极（n = 14）的比例相同。总体而言，83%的肿瘤为外生性。在平均35.3个月（范围：12 - 83个月）的随访期内，RFA后成像未在消融床发现残留或复发的强化肿块。所有患者均在单次治疗中完成，无需对任何病灶进行二次消融；RFA后首次成像研究的技术成功率（无残留肿瘤）为46例中的46例（100%）。46个病灶中有45个（98%）取得临床成功；在术后第127天的移植前肾切除标本中发现了残留的存活肿瘤。无癌生存的平均时间为36.2个月。消融前后肾功能的比较未发现统计学上的显著变化。
我们的RFA后成像和临床监测结果一致，这使我们能够为T1a期RCCa患者提供影像引导下的消融治疗，作为一种可提供长期无癌生存的有效治疗选择。在精心挑选的T1a期RCCa患者群体中，基于阻抗的RFA是一种可靠的治疗选择，其无病生存率与部分肾切除术相当。
