Zhou Wenhui, Arellano Ronald S
School of Medicine, Tufts University, Boston, Massachusetts.
Division of Interventional Radiology, Massachusetts General Hospital, 55 Fruit St., GRB 293, Boston, MA 02114.
J Vasc Interv Radiol. 2018 Jul;29(7):943-951. doi: 10.1016/j.jvir.2017.12.020. Epub 2018 Apr 6.
To evaluate perioperative outcomes of thermal ablation with microwave (MW), radiofrequency (RF), and cryoablation for stage T1c renal cell carcinoma (RCC).
A retrospective analysis of 384 patients (mean age, 71 y; range, 22-88 y) was performed between October 2006 and October 2016. Mean radius, exophytic/endophytic, nearness to collecting system or sinus, anterior/posterior, and location relative to polar lines; preoperative aspects and dimensions used for anatomic classification; and centrality index scores were 6.3, 7.9, and 2.7, respectively. Assessment of pre- and postablation serum blood urea nitrogen, creatinine, and estimated glomerular filtration rate was performed to assess functional outcomes. Linear regression analyses were performed to compare sedation medication dosages among the three treatment cohorts. Univariable and multivariable logistic regression analyses were performed to compare rates of residual disease and complications among treatment modalities.
A total of 437 clinical stage T1N0M0 biopsy-proven RCCs measuring 1.2-6.9 cm were treated with computed tomography (CT)-guided MW ablation (n = 44; 10%), RF ablation (n = 347; 79%), or cryoablation (n = 46; 11%). There were no significant differences in patient demographic or tumor characteristics among cohorts. Complication rates and immediate renal function changes were similar among the three ablation modalities (P = .46 and P = .08, respectively). MW ablation was associated with significantly decreased ablation time (P < .05), procedural time (P < .05), and dosage of sedative medication (P < .05) compared with RF ablation and cryoablation.
CT-guided percutaneous MW ablation is comparable to RF ablation or cryoablation for the treatment of stage T1N0M0 RCC with regard to treatment response and is associated with shorter treatment times and less sedation than RF ablation or cryoablation. In addition, the safety profile of CT-guided MW ablation is noninferior to those of RF ablation or cryoablation.
评估微波（MW）、射频（RF）及冷冻消融治疗T1c期肾细胞癌（RCC）的围手术期结果。
对2006年10月至2016年10月期间的384例患者（平均年龄71岁；范围22 - 88岁）进行回顾性分析。平均半径、外生性/内生性、与集合系统或肾窦的接近程度、前后位以及相对于极线的位置；用于解剖学分类的术前特征和尺寸；中心性指数评分分别为6.3、7.9和2.7。评估消融前后血清血尿素氮、肌酐及估算肾小球滤过率以评估功能结果。进行线性回归分析以比较三个治疗队列中的镇静药物剂量。进行单变量和多变量逻辑回归分析以比较不同治疗方式的残留疾病率和并发症发生率。
共有437例经活检证实为临床分期T1N0M0的RCC，大小为1.2 - 6.9 cm，接受了计算机断层扫描（CT）引导下的MW消融（n = 44；10%）、RF消融（n = 347；79%）或冷冻消融（n = 46；11%）。各队列间患者人口统计学特征或肿瘤特征无显著差异。三种消融方式的并发症发生率和即刻肾功能变化相似（分别为P = 0.46和P = 0.08）。与RF消融和冷冻消融相比，MW消融的消融时间（P < 0.05）、手术时间（P < 0.05）和镇静药物剂量（P < 0.05）显著缩短。
在治疗反应方面，CT引导下经皮MW消融治疗T1N0M0期RCC与RF消融或冷冻消融相当，且与RF消融或冷冻消融相比，治疗时间更短，镇静程度更低。此外，CT引导下MW消融的安全性不劣于RF消融或冷冻消融。
