Rivero J Ricardo, De La Cerda Jose, Wang Hanzhang, Liss Michael A, Farrell Ann M, Rodriguez Ronald, Suri Rajeev, Kaushik Dharam
Department of Urology, University of Texas Health, San Antonio, Texas.
Department of Urology, University of Texas Health, San Antonio, Texas; Cancer Therapy and Research Center, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr., San Antonio, TX 78229-3900.
J Vasc Interv Radiol. 2018 Jan;29(1):18-29. doi: 10.1016/j.jvir.2017.08.013.
A systematic review and meta-analysis of clinical trials was undertaken to compare percutaneous thermal ablation versus partial nephrectomy (PN) for stage T1 renal tumors.
A comprehensive search of major databases was conducted from October 2000 to July 2016. Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were followed. Incidences of all-cause mortality (ACM), cancer-specific mortality (CSM), local recurrence (LR), and metastases, as well as complication rates and changes in estimated glomerular filtration rate (eGFR), were evaluated.
Inclusion criteria were met by 15 of 961 papers. These studies represented 3,974 patients who had undergone an ablative procedure (cryoablation or radiofrequency ablation; n = 1,455; 37%) or PN (n = 2,519; 63%). ACM and CSM rates were higher for ablation than for PN (hazard ratio [HR], 2.11; 95% confidence interval [CI], 1.54-2.87 [P < .05]; HR, 3.84; 95% CI, 1.66-8.88 [P < .05], respectively). No statistically significant difference in LR rate or risk of metastasis was seen between ablation and PN (HR, 1.32; 95% CI, 0.79-2.22 [P = .22]; HR, 1.83; 95% CI, 0.67-5.01 [P = 0.23], respectively). Complication rates were lower for ablation than for PN (13% vs 17.6%; odds ratio, 0.49; 95% CI, 0.25-0.94; P < .05). A significantly greater decrease in eGFR was observed after PN (13.09 mL/min/1.73 m) vs ablation therapy (4.47 mL/min/1.73 m).
Thermal ablation showed no significant difference in LR or metastases compared with PN. Thermal ablation was associated with a lower morbidity rate and a lesser reduction in eGFR compared with PN, but with higher ACM and CSM rates.
进行一项临床试验的系统评价和荟萃分析，以比较经皮热消融术与部分肾切除术（PN）治疗T1期肾肿瘤的疗效。
于2000年10月至2016年7月对主要数据库进行全面检索。遵循系统评价和荟萃分析的首选报告项目指南。评估全因死亡率（ACM）、癌症特异性死亡率（CSM）、局部复发（LR）、转移发生率以及并发症发生率和估计肾小球滤过率（eGFR）的变化。
961篇论文中有15篇符合纳入标准。这些研究共纳入3974例患者，其中接受消融治疗（冷冻消融或射频消融；n = 1455；37%）或PN治疗（n = 2519；63%）。消融组的ACM和CSM发生率高于PN组（风险比[HR]，2.11；95%置信区间[CI]，1.54 - 2.87 [P <.05]；HR，3.84；95% CI，1.66 - 8.88 [P <.05]）。消融组与PN组在LR发生率或转移风险方面无统计学显著差异（HR，1.32；95% CI，0.79 - 2.22 [P =.22]；HR，1.83；95% CI，0.67 - 5.01 [P = 0.23]）。消融组的并发症发生率低于PN组（13%对17.6%；优势比，0.49；95% CI，0.25 - 0.94；P <.05）。与消融治疗（4.47 mL/min/1.73 m²）相比，PN治疗后eGFR的下降幅度更大（13.09 mL/min/1.73 m²）。
与PN相比，热消融术在LR或转移方面无显著差异。与PN相比，热消融术的发病率较低，eGFR降低幅度较小，但ACM和CSM发生率较高。
