Uhlig Annemarie, Hahn Oliver, Strauss Arne, Lotz Joachim, Trojan Lutz, Müller-Wille René, Uhlig Johannes
Department of Urology, University Medical Center Goettingen, Robert-Koch-Strasse 40, 37075, Goettingen, Germany.
Department of Interventional and Diagnostic Radiology, University Medical Center Goettingen, Robert-Koch-Strasse 40, 37075, Goettingen, Germany.
Cardiovasc Intervent Radiol. 2018 Feb;41(2):277-283. doi: 10.1007/s00270-017-1816-9. Epub 2017 Oct 26.
To evaluate survival of patients with localized T1a clear cell renal cell carcinoma (ccRCC) who received cryosurgery or thermal ablation compared to deferred therapy.
We included 733 patients with histopathologically confirmed localized T1a ccRCC who either received cryosurgery (n = 315) or thermal ablation (n = 155), as well as patients who deferred therapy (n = 263) from the 2000-2013 Surveillance, Epidemiology, and End Results Program urinary cancer file. Cox proportional hazard models were used to compare cancer-specific survival (CSS) across subgroups. Sensitivity analyses were conducted to assess potential unmeasured confounding by comorbidities.
Patients treated with cryosurgery and thermal ablation had a statistically significant CSS benefit compared to those who deferred therapy (cryosurgery HR 0.25, 95% CI 0.14-0.45, p < 0.001; thermal ablation HR 0.27, 95% CI 0.13-0.55, p < 0.001, after adjustment for age at diagnosis, tumor grade, and size). There was no significant difference in CSS comparing cryosurgery to thermal ablation (HR 1.03, 95% CI 0.45-2.3, p = 0.95, after adjustment for age at diagnosis, tumor grade, and size). These results proved robust upon sensitivity analyses: After adjustment for comorbidities with varying prevalence assumptions, the corrected hazard ratio (cHR) of cryosurgery versus deferred therapy ranged between HR 0.09 and 0.68.
Local ablative techniques provide relevant survival benefit and are preferable alternatives over deferred therapy. Cryosurgery and thermal ablation yield comparable outcomes.
2b according to the Oxford Centre for evidence-based medicine levels of evidence.
评估接受冷冻手术或热消融治疗的局限性T1a期透明细胞肾细胞癌（ccRCC）患者与延迟治疗患者的生存率。
我们纳入了733例经组织病理学确诊的局限性T1a期ccRCC患者，其中接受冷冻手术的患者有315例，接受热消融治疗的患者有155例，还有263例来自2000 - 2013年监测、流行病学和最终结果计划泌尿系统癌症档案中延迟治疗的患者。采用Cox比例风险模型比较各亚组的癌症特异性生存率（CSS）。进行敏感性分析以评估合并症可能存在的未测量混杂因素。
与延迟治疗的患者相比，接受冷冻手术和热消融治疗的患者在CSS方面具有统计学显著优势（冷冻手术HR 0.25，95%CI 0.14 - 0.45，p < 0.001；热消融HR 0.27，95%CI 0.13 - 0.55，p < 0.001，在调整诊断年龄、肿瘤分级和大小后）。比较冷冻手术和热消融的CSS没有显著差异（HR 1.03，95%CI 0.45 - 2.3，p = 0.95，在调整诊断年龄、肿瘤分级和大小后）。这些结果在敏感性分析中得到了验证：在根据不同患病率假设调整合并症后，冷冻手术与延迟治疗的校正风险比（cHR）在HR 0.09至0.68之间。
局部消融技术可带来显著的生存获益，是优于延迟治疗的选择。冷冻手术和热消融产生相似的结果。
根据牛津循证医学中心的证据级别为2b级。
