From the Division of Interventional Radiology, Department of Radiology and Biomedical Imaging (J.U., N.K., M.X., H.S.K.), Division of Medical Oncology, Department of Medicine (H.S.K.), and Yale Cancer Center (H.S.K.), Yale School of Medicine, 330 Cedar St, TE 2-224, New Haven, CT 06510; Department of Diagnostic and Interventional Radiology, University Medical Center, Goettingen, Germany (J.U.); Division of Interventional Radiology and Image Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine (N.K.); and Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Md (M.X.).
Radiology. 2018 Sep;288(3):889-897. doi: 10.1148/radiol.2018172960. Epub 2018 Jul 3.
Purpose To compare patients in a national U.S. database who underwent thermal ablation or nephrectomy for renal cell carcinoma (RCC) in terms of demographic differences, perioperative outcomes, and survival. Materials and Methods This National Cancer Database study included patients who underwent thermal ablation or nephrectomy for biopsy-proven T1aN0M0 RCC between 2004 and 2013. Demographic factors were analyzed as treatment predictors. Unplanned hospital readmission, mean hospital stay, 30- and 90-day postoperative mortality, and survival were analyzed in a propensity score-matched cohort by using χ tests, Cox proportional hazards models, and Renyi family tests. Results Included were 4817 of 56 065 patients (8.6%) who underwent thermal ablation and 51 248 of 56 065 patients (91.4%) who underwent nephrectomy. Patients who underwent thermal ablation skewed older (mean, 52 years vs 44 years, respectively) with more comorbidities (9% vs 7.6% Charlson Comorbidity Index score of ≥2, respectively). Male sex, white race, nonprivate insurance, therapy at academic centers, and south Atlantic state urban residence with lower income and education were associated with higher thermal ablation treatment likelihood (P < .001). After matching, perioperative outcomes were superior for thermal ablation: unplanned hospital readmission, mean hospital stay, and 30- and 90-day postoperative mortality were lower for thermal ablation (2% vs 3.3%, 1.3 days vs 4.3 days, 0% vs 0.9%, and 0% vs 1.4%, respectively; each P < .001). Survival was comparable for thermal ablation and nephrectomy in patients older than 65 years, and during the 1st postoperative year for all patients. Conclusion Thermal ablation for RCC varied by national region and with multiple clinical and nonclinical demographic factors. Thermal ablation demonstrates superior perioperative outcomes with short mean hospital stay, low unplanned hospital readmission, and 30- and 90-day mortality. In selected patients, thermal ablation survival may be comparable to nephrectomy.
目的 比较美国国家数据库中接受热消融或肾切除术治疗肾细胞癌（RCC）的患者，以评估人口统计学差异、围手术期结果和生存情况。 材料与方法 本研究基于美国国家癌症数据库，纳入 2004 年至 2013 年间接受热消融或肾切除术治疗活检证实的 T1aN0M0RCC 的患者。分析人口统计学因素作为治疗预测因素。采用卡方检验、Cox 比例风险模型和 Renyi 家族检验，对未计划的住院再入院率、平均住院时间、术后 30 天和 90 天死亡率和生存率进行倾向评分匹配队列分析。 结果 56065 例患者中，4817 例（8.6%）接受热消融治疗，51248 例（91.4%）接受肾切除术治疗。热消融组患者年龄偏大（平均年龄 52 岁 vs 44 岁），合并症更多（9% vs 7.6%，Charlson 合并症指数评分≥2）。男性、白种人、非私人保险、在学术中心接受治疗以及位于南大西洋州、城市、收入和教育程度较低的患者，接受热消融治疗的可能性更高（均 P＜0.001）。匹配后，热消融组的围手术期结果更好：未计划的住院再入院率、平均住院时间、术后 30 天和 90 天死亡率更低（2% vs 3.3%，1.3 天 vs 4.3 天，0% vs 0.9%，0% vs 1.4%；均 P＜0.001）。对于年龄大于 65 岁的患者和所有患者的术后 1 年内，热消融和肾切除术的生存率相当。 结论 美国不同地区、不同患者的 RCC 治疗方式存在差异，影响因素包括多种临床和非临床的人口统计学因素。热消融治疗 RCC 具有优越的围手术期结果，表现为平均住院时间短、未计划的住院再入院率低、术后 30 天和 90 天死亡率低。在某些特定患者中，热消融的生存率可能与肾切除术相当。
