T1a期肾细胞癌实时温度监测下射频消融后的长期肿瘤学结局

Long-term oncologic outcomes following radiofrequency ablation with real-time temperature monitoring for T1a renal cell cancer.

作者信息

Lorber Gideon, Glamore Michael, Doshi Mehul, Jorda Merce, Morillo-Burgos Gaston, Leveillee Raymond J

机构信息

Department of Urology, University of Miami, Miller School of Medicine, Miami, FL.

Florida International University, College of Medicine, Miami, FL.

出版信息

Urol Oncol. 2014 Oct;32(7):1017-23. doi: 10.1016/j.urolonc.2014.03.005. Epub 2014 Jul 2.

DOI:10.1016/j.urolonc.2014.03.005

PMID:24996776

Abstract

OBJECTIVE

Few studies report long-term follow-up of renal cancer treated by radiofrequency ablation (RFA), thus limiting the comparison of this modality to well-established long-term follow-up series of surgically resected renal masses. Herein, we report long-term oncologic outcomes of renal cancer treated with RFA in a single institution.

METHODS AND MATERIALS

We retrospectively reviewed patients treated between November 2001 and October 2012 with laparoscopic-guided or computed tomography-guided RFA. All treatments were performed with real-time thermometry ensuring target ablation temperature (>60°C) was adequately reached. Only patients with biopsy-confirmed T1a-category cancer and a follow-up period>48 months were included in our analysis. Follow-up included office visits, laboratory work, and periodic contrast-enhanced imaging. Survival was calculated using the Kaplan-Meier analysis. Overall complications were reported using the Clavien-Dindo scale.

RESULTS

Of 434 RFA cases, 53 treatments in 50 patients met the inclusion criteria. Of these, 29 were treated with computed tomography-guided RFA and 24 with laparoscopic-guided RFA. The mean follow-up interval was 65.6 months (48.5-120.2), and the mean renal mass size was 2.3 cm (0.3-4.0). There were 4 (7.5%) local recurrences and 1 case of distant metastases with no local recurrence. The 5-year overall survival was 98%, cancer-specific survival was 100%, and recurrence-free survival was 92.5%. The complication rate was 26.4%, which included 71% of Clavien-Dindo grade I and 29% of grade II. Mean estimated glomerular filtration rate preoperatively and at the most recent follow-up visit was 77 and 66 ml/min, respectively.

CONCLUSIONS

When performed on selected patients, while monitoring real-time temperatures to ensure adequate treatment end points, RFA offers favorable long-term oncologic outcomes approaching those reported for partial nephrectomy.

摘要

目的

很少有研究报告经射频消融（RFA）治疗的肾癌的长期随访情况，因此限制了将这种治疗方式与已确立的手术切除肾肿块的长期随访系列进行比较。在此，我们报告在单一机构中接受RFA治疗的肾癌的长期肿瘤学结果。

方法和材料

我们回顾性分析了2001年11月至2012年10月期间接受腹腔镜引导或计算机断层扫描引导下RFA治疗的患者。所有治疗均采用实时测温，以确保充分达到目标消融温度（>60°C）。我们的分析仅纳入活检确诊为T1a期癌症且随访时间>48个月的患者。随访包括门诊就诊、实验室检查和定期增强对比成像。使用Kaplan-Meier分析计算生存率。使用Clavien-Dindo量表报告总体并发症情况。

结果

在434例RFA病例中，50例患者的53次治疗符合纳入标准。其中，29例接受计算机断层扫描引导下的RFA治疗，24例接受腹腔镜引导下的RFA治疗。平均随访间隔为65.6个月（48.5 - 120.2个月），平均肾肿块大小为2.3 cm（0.3 - 4.0 cm）。有4例（7.5%）局部复发，1例远处转移且无局部复发。5年总生存率为98%，癌症特异性生存率为100%，无复发生存率为92.5%。并发症发生率为26.4%，其中Clavien-Dindo I级占71%，II级占29%。术前和最近一次随访时的平均估计肾小球滤过率分别为77和66 ml/min。