Bhindi Bimal, Thompson Robert Houston, Mason Ross J, Haddad Mustafa M, Geske Jennifer R, Kurup Anil Nicholas, Hannon James D, Boorjian Stephen A, Leibovich Bradley C, Atwell Thomas D, Schmit Grant D
Department of Urology, Mayo Clinic, Rochester, MN, USA.
Department of Radiology, Mayo Clinic, Rochester, MN, USA.
BJU Int. 2017 Jun;119(6):905-912. doi: 10.1111/bju.13841. Epub 2017 Apr 9.
To evaluate the association between renal tumour complexity and outcomes in a large cohort of patients undergoing percutaneous cryoablation (PCA).
Patients with renal tumours treated with PCA were identified using our prospectively maintained ablation registry (2003-2015). Salvage procedures and inherited tumour syndromes were excluded. The associations between R.E.N.A.L. nephrometry score (NS) and risk of complications, renal function impairment, local failure and cancer-specific mortality (CSM) were evaluated using univariate and multivariable logistic, linear and Cox regression models.
The cohort included 618 tumours treated during 580 procedures in 565 patients. The median (interquartile range [IQR]) follow-up was 34 (14.66) months. Complications (any grade) during a procedure (n[total] = 87, 15%) were more frequent with higher NS (NS 4-6: 10%; NS 7-9: 14%; NS 10-12: 36%; P < 0.001). Higher NS was independently associated with risk of complications (odds ratio [OR; per 1 point] = 1.3; 95% confidence interval [CI] 1.2-1.5; P < 0.001). Of all the NS components, tumour size was the most strongly associated with complication risk (OR 3.4; 95% CI 2.2-5.2; P < 0.001). The median (IQR) decline in glomerular filtration rate (GFR) from baseline was 9% (0, 22) at last follow-up. Each additional point in NS was associated with a 1.3% (95% CI 0.4-2.1; P = 0.005) greater GFR decline from baseline. NS was not significantly associated with local failure (n [total] = 14, 2%; NS 4-6: 2%; NS 7-9: 3%; NS 10-12: 5%; P = 0.32) or CSM (n [total] = 8, 2%; NS 4-6: 2%; NS 7-9: 3%; NS 10-12: 2%; P = 0.88).
In high-complexity tumours PCA was associated with a tumour size-driven increased risk of post-procedural complications. Higher NS was associated with a small, clinically minor additional decline in renal function. Risks for local failure and CSM were low, regardless of tumour complexity.
在接受经皮冷冻消融术（PCA）的一大群患者中评估肾肿瘤复杂性与治疗结果之间的关联。
使用我们前瞻性维护的消融登记册（2003 - 2015年）确定接受PCA治疗的肾肿瘤患者。排除补救性手术和遗传性肿瘤综合征患者。使用单变量和多变量逻辑回归、线性回归和Cox回归模型评估R.E.N.A.L.肾计量评分（NS）与并发症风险、肾功能损害、局部复发和癌症特异性死亡率（CSM）之间的关联。
该队列包括565例患者接受的580次手术中治疗的618个肿瘤。中位（四分位间距[IQR]）随访时间为34（14.66）个月。手术期间并发症（任何级别）（n[总计]=87，15%）在NS较高的患者中更常见（NS 4 - 6：10%；NS 7 - 9：14%；NS 10 - 12：36%；P<0.001）。较高的NS与并发症风险独立相关（优势比[OR；每1分]=1.3；95%置信区间[CI]1.2 - 1.5；P<0.001）。在所有NS组成部分中，肿瘤大小与并发症风险的相关性最强（OR 3.4；95% CI 2.2 - 5.2；P<0.001）。在最后一次随访时，肾小球滤过率（GFR）较基线的中位（IQR）下降为9%（0，22）。NS每增加1分与GFR较基线多下降1.3%（95% CI 0.4 - 2.1；P = 0.005）相关。NS与局部复发（n[总计]=14，2%；NS 4 - 6：2%；NS 7 - 9：3%；NS 10 - 12：5%；P = 0.32）或CSM（n[总计]=8，2%；NS 4 - 6：2%；NS 7 - 9：3%；NS 10 - 12：2%；P = 0.88）无显著关联。
在高复杂性肿瘤中，PCA与肿瘤大小驱动的术后并发症风险增加相关。较高的NS与肾功能轻微的额外下降相关。无论肿瘤复杂性如何，局部复发和CSM的风险都较低。
