Vernez Simone L, Okhunov Zhamshid, Kaler Kamaljot, Youssef Ramy F, Dutta Rahul, Palvanov Arkadiy, Shah Paras, Osann Kathryn, Siegel David N, Lobko Igor, Kavoussi Louis, Clayman Ralph V, Landman Jaime
Department of Urology, University of California, Irvine, Orange, CA.
The Arthur Smith Institute of Urology, North Shore LIJ Health System, Great Neck, NY.
Urology. 2017 Oct;108:195-200. doi: 10.1016/j.urology.2017.06.026. Epub 2017 Jun 23.
To determine the impact of skin-to-tumor (STT) distance on the risk for treatment failure following percutaneous cryoablation (PCA).
We retrospectively reviewed patients who underwent PCA with documented T1a recurrent renal cell carcinoma (RCC) at 2 academic centers between 2005 and 2015. Patient demographics, tumor characteristics, and perioperative and postoperative course variables were collected. Additionally, we measured the STT distance by averaging the distance from the skin to the center of the tumor at 0°, 45°, and 90° on preoperative computed tomography imaging.
We identified 86 patients with documented T1a RCC. The mean age at the time of surgery was 69 years (range: 37-91 years), and the mean tumor size was 2.7 cm (range: 1.0-4.0 cm). With a mean follow-up of 24 months (range: 3-63 months), 11 (12.8%) treatment failures occurred. Patients with treatment failure had significantly higher mean STT distance than those without: 11.0 cm (range: 6.3-20.1 cm) compared to 8.4 cm (range: 4.4-15.2 cm), respectively (P = .002). STT distance was an independent predictor of treatment failure (odds ratio: 1.32, 95% confidence interval: 1.04-1.69, P = .029). STT distance greater than 10 cm had a fourfold increased risk of tumor treatment failure (odds ratio: 4.43, 95% confidence interval: 1.19-16.39, P = .018). Tumor size, R.E.N.A.L. Nephrometry score, and number of cryoprobes placed were not associated with treatment failure.
STT, an easily measured preoperative variable, may inform the risk of RCC treatment failure following PCA.
确定皮肤至肿瘤（STT）距离对经皮冷冻消融术（PCA）后治疗失败风险的影响。
我们回顾性分析了2005年至2015年间在2个学术中心接受PCA治疗且记录为T1a期复发性肾细胞癌（RCC）的患者。收集患者的人口统计学资料、肿瘤特征以及围手术期和术后病程变量。此外，我们通过术前计算机断层扫描成像在0°、45°和90°测量从皮肤到肿瘤中心的距离，并取其平均值来测量STT距离。
我们确定了86例记录为T1a期RCC的患者。手术时的平均年龄为69岁（范围：37 - 91岁），平均肿瘤大小为2.7 cm（范围：1.0 - 4.0 cm）。平均随访24个月（范围：3 - 63个月），发生了11例（12.8%）治疗失败。治疗失败的患者平均STT距离显著高于未失败的患者：分别为11.0 cm（范围：6.3 - 20.1 cm）和8.4 cm（范围：4.4 - 15.2 cm）（P = .002）。STT距离是治疗失败的独立预测因素（比值比：1.32，95%置信区间：1.04 - 1.69，P = .029）。STT距离大于10 cm时肿瘤治疗失败风险增加四倍（比值比：4.43，95%置信区间：1.19 - 16.39，P = .018）。肿瘤大小、R.E.N.A.L.肾计量评分和放置的冷冻探针数量与治疗失败无关。
STT是一个易于测量的术前变量，可能提示PCA后RCC治疗失败的风险。
