Martin Jeremy W, Patel Roshan M, Okhunov Zhamshid, Vyas Aashay, Vajgrt Duane, Clayman Ralph V
1 Department of Urology, University of California , Irvine, Irvine, California.
2 Department of Radiology, University of California , Irvine, Irvine, California.
J Endourol. 2017 Apr;31(4):355-360. doi: 10.1089/end.2016.0864. Epub 2017 Feb 17.
Cryoablation (CA) is a minimally invasive modality for the management of small renal cortical neoplasms (RCN). Effective ablation is dependent on achieving target temperatures during CA that result in tumor cell death. We investigated long-term oncologic outcomes following CA using multipoint thermal sensors (MTS), which allow precise temperature determination at four points along the needle.
We performed a retrospective review of 20 patients with <4 cm RCN who underwent de novo CA from 2005 to 2009. In 11 procedures, MTS needles were deployed with the goal of obtaining -20°C at the tumor margin, while 9 were done without MTS. Patient demographics, tumor characteristics, and CA procedure data were retrieved and analyzed. Follow-up CT or MRI was used to assess recurrence status.
With a mean follow-up of 45 months, none of the 11 patients experienced a recurrence in the MTS group, compared with 4 of 9 (44.4%) patients in the non-MTS group (p = 0.026). Of the biopsy-confirmed renal cancers, none of the 6 in the MTS group, compared with 3 of 6 (50%) in the non-MTS group, recurred (p = 0.182). Age, tumor size, surgical approach, tumor histopathology, grade, follow-up time, and skin-to-tumor distance were similar between the MTS and non-MTS groups. The MTS group was also associated with increased total length of freeze (p = 0.041), procedure time (p = 0.020), cryoprobe utilization (p = 0.049), and a greater ratio of cryoprobes used per cm diameter of tumor (p = 0.003).
In this small renal mass pilot study, the use of MTS needles to monitor temperature and guide cryoneedle deployment was associated with improved oncologic outcomes.
冷冻消融术（CA）是一种用于治疗小肾皮质肿瘤（RCN）的微创方法。有效的消融取决于在冷冻消融过程中达到导致肿瘤细胞死亡的目标温度。我们使用多点热传感器（MTS）研究了冷冻消融术后的长期肿瘤学结局，该传感器可在针的四个点精确测定温度。
我们对2005年至2009年接受初治冷冻消融术的20例肾肿瘤直径<4 cm的患者进行了回顾性研究。在11例手术中，使用MTS针的目的是使肿瘤边缘达到-20°C，而9例手术未使用MTS。检索并分析患者的人口统计学、肿瘤特征和冷冻消融手术数据。采用随访CT或MRI评估复发情况。
平均随访45个月，MTS组11例患者均未复发，而非MTS组9例患者中有4例（44.4%）复发（p = 0.026）。在活检确诊的肾癌中，MTS组6例均未复发，而非MTS组6例中有3例（50%）复发（p = 0.182）。MTS组和非MTS组在年龄、肿瘤大小、手术方式、肿瘤组织病理学、分级、随访时间以及皮肤至肿瘤距离方面相似。MTS组还与冷冻总时长增加（p = 0.041）、手术时间增加（p = 0.020）、冷冻探针使用量增加（p = 0.049）以及每厘米肿瘤直径使用的冷冻探针比例更高（p = 0.003）相关。
在这项小肾肿块的初步研究中，使用MTS针监测温度并指导冷冻针的放置与改善肿瘤学结局相关。
