Department of Urology, Mayo Clinic, Rochester, MN, USA.
Department of Radiology, Mayo Clinic, Rochester, MN, USA.
Eur Urol. 2018 Feb;73(2):254-259. doi: 10.1016/j.eururo.2017.09.009. Epub 2017 Sep 28.
While partial nephrectomy (PN) is considered the standard approach for a tumor in a solitary kidney, percutaneous cryoablation (PCA) is emerging as an alternative nephron-sparing option.
To compare outcomes between PCA and PN for tumors in a solitary kidney.
DESIGN, SETTING, AND PARTICIPANTS: Patients who underwent PCA or PN between 2005 and 2015 for a single primary renal tumor in a solitary kidney were identified using Mayo Clinic Registries. Exclusion criteria were inherited tumor syndromes and salvage procedures.
PCA and PN.
To achieve balance in baseline characteristics, we used inverse probability of treatment weighting (IPTW) based on propensity to receive treatment. The risk of having a post-treatment complication and percent drop in estimated glomerular filtration rate (eGFR), as well as the risks of local/ipsilateral recurrence, distant metastasis, and cancer-specific mortality, were compared between groups using logistic, linear, and Fine-and-Gray competing risk regression models.
The cohort included 118 patients (PCA: 54; PN: 64) with a median follow-up of 47 mo (interquartile range 18, 74). In unadjusted analyses, PCA was associated with a lower risk of complications (15% vs 31%; odds ratio [OR]=0.38; 95% confidence interval [CI] 0.15, 0.96; p=0.04). However, upon accounting for baseline differences with IPTW adjustment, there was no longer a significant difference in the risk of complications (28% vs 29%; OR=0.95; 95% CI 0.53, 1.69; p=0.9). There were no significant differences between PCA and PN in percentage drop in eGFR at discharge (mean: 11% vs 16%; β=-5%; 95% CI -13, 3; p=0.2) or at 3 mo (12% vs 9%; β=3%; 95% CI -3, 10; p=0.3). Likewise, no significant differences were noted in local recurrence (HR=0.87; 95% CI 0.38, 1.98; p=0.7), distant metastases (HR=0.60; 95% CI 0.30, 1.20; p=0.2), or cancer-specific mortality (HR=1.13; 95% CI 0.32, 3.98; p=0.8). Limitations include the sample size, given the relative rarity of renal masses in solitary kidneys.
Our study found no significant difference in complications, renal function outcomes, and oncologic outcomes between PN and PCA for patients with a tumor in a solitary kidney. Validation in a larger multi-institutional analysis may be warranted.
Partial nephrectomy (surgery) and percutaneous cryoablation are both options for treating a kidney tumor while preserving the normal portion of the kidney. In patients with a tumor in their only kidney, we found no difference in the risk of complications, kidney function outcomes, or cancer control outcomes between these two approaches.
虽然部分肾切除术 (PN) 被认为是治疗孤立肾中肿瘤的标准方法，但经皮冷冻消融术 (PCA) 作为一种保肾的替代方法正在出现。
比较 PCA 和 PN 治疗孤立肾肿瘤的结果。
设计、地点和参与者：使用 Mayo 诊所注册中心确定了 2005 年至 2015 年间接受 PCA 或 PN 治疗孤立肾中单个原发性肾肿瘤的患者。排除标准为遗传性肿瘤综合征和挽救性手术。
PCA 和 PN。
为了在基线特征上实现平衡，我们使用基于治疗倾向的逆概率治疗加权 (IPTW)。使用逻辑、线性和 Fine-and-Gray 竞争风险回归模型比较组间治疗后并发症的风险、估计肾小球滤过率 (eGFR) 的下降百分比、局部/同侧复发、远处转移和癌症特异性死亡率的风险。
该队列包括 118 名患者（PCA：54 名；PN：64 名），中位随访时间为 47 个月（四分位距 18，74）。在未调整分析中，PCA 与较低的并发症风险相关（15% 比 31%；优势比 [OR] = 0.38；95%置信区间 [CI] 0.15，0.96；p=0.04）。然而，在进行 IPTW 调整以考虑基线差异后，并发症风险不再有显著差异（28% 比 29%；OR=0.95；95%CI 0.53，1.69；p=0.9）。在出院时 eGFR 的下降百分比（平均值：11% 比 16%；β=-5%；95%CI -13，3；p=0.2）或 3 个月时（12% 比 9%；β=3%；95%CI -3，10；p=0.3），PCA 和 PN 之间也没有显著差异。同样，局部复发（HR=0.87；95%CI 0.38，1.98；p=0.7）、远处转移（HR=0.60；95%CI 0.30，1.20；p=0.2）或癌症特异性死亡率（HR=1.13；95%CI 0.32，3.98；p=0.8）也没有显著差异。局限性包括样本量，考虑到孤立肾中肾肿瘤的相对罕见性。
我们的研究发现，PN 和 PCA 治疗孤立肾肿瘤患者的并发症、肾功能结果和肿瘤学结果无显著差异。可能需要在更大的多机构分析中进行验证。
部分肾切除术（手术）和经皮冷冻消融术都是治疗保留正常肾脏部分的肾肿瘤的选择。对于只有一个肾脏的肿瘤患者，我们发现这两种方法在并发症风险、肾功能结果或癌症控制结果方面没有差异。
