Beksac Alp Tuna, Rivera-Sanfeliz Gerant, Dufour Catherine A, Nseyo Unwanaobong, Hamilton Zachary, Berquist Sean W, Hassan Abd-elRahman, Raheem Omer A, Wang Song, Wake Robert W, Gold Robert E, Derweesh Ithaar H
Department of Urology, Moores UCSD Cancer Center, University of California San Diego School of Medicine, 3855 Health Sciences Drive, Mail Code: 0987, La Jolla, CA, 92093-0987, USA.
Department of Radiology, University of California San Diego School of Medicine, La Jolla, CA, USA.
World J Urol. 2017 Apr;35(4):633-640. doi: 10.1007/s00345-016-1911-6. Epub 2016 Aug 2.
We analyzed oncological outcomes in patients who underwent percutaneous renal cryoablation (PRC) with documented renal cell carcinoma (RCC) by perioperative biopsy.
Multicenter retrospective analysis of 153 patients [median follow-up 48 months] who underwent PRC from 09/2005 to 08/2014 was performed. We divided the cohort into patients who developed recurrence versus no recurrence. Kaplan-Meier analyses examined recurrence-free survival (RFS) according to grade and histology. Multivariable analysis (MVA) was performed to identify factors associated with tumor recurrence.
One hundred and fifty-three patients were analyzed [18 patients (11.8 %) with recurrence and 135 (88.2 %) patients without recurrence]. There were no differences between the groups with respect to demographics, RENAL score, and number of probes utilized. Recurrence group had larger tumor size (3.1 vs. 2.4 cm; p = 0.011), upper pole tumor location (p = 0.016), and greater proportions of high-grade tumor (33 vs. 0.7 %; p < 0.001) and clear cell histology (77.8 vs. 45.9 %; p = 0.011). Four-year RFS was 100 versus 80 % for grade 1 versus grade 2/3 tumors (p = 0.0002), and 97 versus 88 % for other RCC versus clear cell RCC (p = 0.07). MVA demonstrated tumor size >3 cm (OR 2.46; p = 0.019), clear cell histology (OR 2.12; p = 0.027), and high tumor grade (OR 2.33, p < 0.001) as independent risk factors associated with tumor recurrence.
Association of higher grade and clear cell histology with recurrence and progression suggests need for increased emphasis on preoperative risk stratification by biopsy, with grade 1 and non-clear cell RCC being associated with improved treatment success than higher grade and clear cell RCC.
我们分析了经围手术期活检证实患有肾细胞癌（RCC）的患者接受经皮肾冷冻消融术（PRC）后的肿瘤学结局。
对2005年9月至2014年8月期间接受PRC的153例患者[中位随访48个月]进行多中心回顾性分析。我们将队列分为出现复发的患者和未复发的患者。采用Kaplan-Meier分析根据分级和组织学检查无复发生存期（RFS）。进行多变量分析（MVA）以确定与肿瘤复发相关的因素。
分析了153例患者[18例（11.8%）复发，135例（88.2%）未复发]。两组在人口统计学、RENAL评分和使用的探针数量方面无差异。复发组肿瘤体积更大（3.1对2.4 cm；p = 0.011），肿瘤位于上极（p = 0.016），高级别肿瘤比例更高（33%对0.7%；p < 0.001），透明细胞组织学比例更高（77.8%对45.9%；p = 0.011）。1级肿瘤与2/3级肿瘤的4年RFS分别为100%和80%（p = 0.0002），其他RCC与透明细胞RCC的4年RFS分别为97%和88%（p = 0.07）。MVA显示肿瘤大小>3 cm（OR 2.46；p = 0.019）、透明细胞组织学（OR 2.12；p = 0.027）和高肿瘤分级（OR 2.33，p < 0.001）是与肿瘤复发相关的独立危险因素。
高级别和透明细胞组织学与复发和进展相关联，这表明需要更加重视通过活检进行术前风险分层，1级和非透明细胞RCC比高级别和透明细胞RCC的治疗成功率更高。
