Pantelidou Maria, Challacombe Ben, McGrath Andrew, Brown Matthew, Ilyas Shahzad, Katsanos Konstantinos, Adam Andreas
Department of Interventional Radiology, Guy's and St. Thomas' Hospitals, NHS Foundation Trust, King's Health Partners, London, SE1 7EH, UK.
Department of Urology, Guy's and St. Thomas' Hospitals, NHS Foundation Trust, King's Health Partners, London, SE1 7EH, UK.
Cardiovasc Intervent Radiol. 2016 Nov;39(11):1595-1603. doi: 10.1007/s00270-016-1417-z. Epub 2016 Jul 19.
The authors compared the oncologic outcomes of radiofrequency ablation (RFA) with robotic-assisted partial nephrectomy (RPN) for the treatment of T1 stage renal cell carcinoma (RCC).
This was a retrospective data analysis of a high-volume single tertiary centre. Patients were treated with RFA or RPN following multidisciplinary decision making. Only histologically proven RCCs were included. Baseline demographics were collected, and PADUA scores of tumour features were calculated to standardize baseline anatomy. Peri-operative complications, kidney function and oncological outcomes were compared.
Sixty-three cases were included in each group. Baseline renal function was poorer in RFA, and 16/63 RFA patients had tumours in single kidneys compared to 1/63 RPN cases (p < 0.001). Length of stay was shorter in RFA (1 vs. 3 days, p < 0.0001). Post-procedure renal function decline at 30 days was significantly less in RFA [(-0.8) ± 9.6 vs. (-16.1) ± 19.5 mls/min/1.73 m; p < 0.0001]. More minor complications were recorded in RPN (10/63 vs. 4/63, p = 0.15), but local recurrence was numerically higher in RFA (6/63 vs. 1/63, p = 0.11). Disease-free survival (DFS) was not significantly different (adjusted HR = 0.6, 95 % Cl 0.1-3.7; p = 0.60). Increasing tumour size was an independent predictor of local recurrence (adjusted HR = 1.7; 95 % Cl 1.1-2.6 per cm; p = 0.02).
Both RPN and RFA offer very good oncological outcomes for the treatment of T1 RCC with low peri-operative morbidity and similar oncologic outcomes. RFA demonstrated fewer peri-operative complications and better preservation of renal function, whereas RPN had an insignificantly lower local recurrence rate. RFA should be offered alongside RPN for selected cases.
作者比较了射频消融（RFA）与机器人辅助部分肾切除术（RPN）治疗T1期肾细胞癌（RCC）的肿瘤学结局。
这是一项对一家大型单一三级中心的回顾性数据分析。患者经多学科决策后接受RFA或RPN治疗。仅纳入经组织学证实的RCC病例。收集基线人口统计学数据，并计算肿瘤特征的PADUA评分以标准化基线解剖结构。比较围手术期并发症、肾功能和肿瘤学结局。
每组纳入63例病例。RFA组的基线肾功能较差，63例RFA患者中有16例肿瘤位于单肾，而RPN组为1/63例（p<0.001）。RFA组的住院时间较短（1天对3天，p<0.0001）。RFA组术后30天肾功能下降明显较少[（-0.8）±9.6对（-16.1）±19.5 ml/min/1.73 m²；p<0.0001]。RPN组记录的轻微并发症更多（10/63对4/63，p = 0.15），但RFA组的局部复发在数值上更高（6/63对1/63，p = 0.11）。无病生存期（DFS）无显著差异（校正风险比=0.6，95%可信区间0.1 - 3.7；p = 0.60）。肿瘤大小增加是局部复发的独立预测因素（校正风险比=1.7；每厘米95%可信区间1.1 - 2.6；p = 0.02）。
RPN和RFA治疗T1期RCC均具有良好的肿瘤学结局且围手术期发病率低，肿瘤学结局相似。RFA显示围手术期并发症较少且肾功能保留更好，而RPN的局部复发率略低。对于选定病例，应将RFA与RPN一起提供给患者。
