Chen James X, Maass Daniel, Guzzo Thomas J, Bruce Malkowicz S, Wein Alan J, Soulen Michael C, Clark Timothy W I, Nadolski Gregory J, William Stavropoulos S
Division of Interventional Radiology, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104.
Division of Urology, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104.
J Vasc Interv Radiol. 2016 Sep;27(9):1397-1406. doi: 10.1016/j.jvir.2016.03.038. Epub 2016 May 24.
To evaluate growth kinetics and oncologic outcomes of patients with renal tumors undergoing active surveillance (AS) for residual viable tumor following percutaneous ablation.
Following percutaneous thermal ablation, residual tumor was detected in 21/133 (16%) patients on initial follow-up imaging, and AS was undertaken in 17/21 (81%) patients. Initial tumor volumes and volumes after ablation were assessed from cross-sectional imaging to calculate volumetric growth rate (VGR) and volume doubling time (VDT) of residual tumor. The rate of metastasis, overall survival, and renal cell carcinoma (RCC)-specific survival were compared between patients in the AS group and in the routine follow up group of patients who did not have residual tumor.
Median tumor volume prior to ablation, after first ablation, and at final follow-up were 25 cm(3), 6 cm(3), and 6 cm(3), respectively, in patients with residual tumor. Stable, mild, and moderate VGR occurred in 8/17 (47%), 4/17 (24%), and 5/17 (29%) cases, respectively. The 4 cases with fastest VDT underwent delayed intervention with ablation (n = 1) and nephrectomy (n = 3) without subsequent residual, recurrence, or metastasis. There was no significant difference in the rates of RCC metastasis, overall survival, or RCC-specific survival between AS and routine follow-up groups. Metastatic RCC and subsequent death occurred in 1 patient in the AS group, after the patient had refused offers for retreatment for local progression over 60.7 months of follow-up.
In cases when patients are not amenable to further intervention, AS of residual tumor may be an acceptable alternative and allows for successful delayed intervention when needed.
评估经皮消融后对肾肿瘤残留存活肿瘤进行主动监测（AS）的患者的生长动力学和肿瘤学结局。
经皮热消融后，21/133例（16%）患者在初次随访成像时检测到残留肿瘤，其中17/21例（81%）患者进行了主动监测。从横断面成像评估初始肿瘤体积和消融后的体积，以计算残留肿瘤的体积生长率（VGR）和体积倍增时间（VDT）。比较主动监测组患者与无残留肿瘤的常规随访组患者之间的转移率、总生存率和肾细胞癌（RCC）特异性生存率。
残留肿瘤患者消融前、首次消融后及末次随访时的中位肿瘤体积分别为25 cm³、6 cm³和6 cm³。8/17例（47%）、4/17例（24%）和5/17例（29%）分别出现稳定、轻度和中度VGR。4例VDT最快的患者接受了延迟干预，包括消融（n = 1）和肾切除术（n = 3），随后无残留、复发或转移。主动监测组与常规随访组之间的RCC转移率、总生存率或RCC特异性生存率无显著差异。主动监测组1例患者在随访60.7个月以上拒绝接受局部进展再治疗后发生转移性RCC并随后死亡。
在患者不适合进一步干预的情况下，残留肿瘤的主动监测可能是一种可接受的选择，并允许在需要时成功进行延迟干预。
