1 Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada.
2 Urology Unit, ASST Spedali Civili of Brescia, Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia, Italy.
J Endourol. 2019 Jul;33(7):606-613. doi: 10.1089/end.2019.0179. Epub 2019 May 17.
Institutional studies suggested that tumor size (TS) might be an independent predictor of recurrence after local tumor ablation (LTA). However, limited data exist to ascertain whether a larger TS may also predispose to a worse cancer-specific mortality (CSM) rate. Patients treated with LTA for T1a nonmetastatic renal-cell carcinoma were identified within the Surveillance, Epidemiology, and End Results (SEER) database (2004-2015). Estimated annual percentage change (EAPC) methodology, cumulative incidence plots, and multivariable competing risk regression (CRR) models before and after the 1:1 ratio propensity score (PS) adjustment were used to compare LTA for TS ≤30 mm TS >30 mm. A comparison of cryosurgery thermal ablation according to TS was also performed. Of 3946 LTA patients, 2974 (75.3%) patients harbored TS ≤30 mm 972 (24.7%) harbored TS >30 mm. The latter was significantly older (median age 67 years 71 years, < 0.001), compared with TS ≤30 mm. No differences were recorded in annual rates over time. In unmatched CRR models, after adjustment for other-cause mortality (OCM) rate, LTA for TS >30 mm showed a worse 5-year CSM rate (hazard ratio [HR] 2.3, < 0.001), relative to TS ≤30 mm. In PS- and OCM rate-adjusted CRR models, LTA for TS >30 mm still showed a worse 5-year CSM rate (HR 2.86, < 0.001), relative to TS ≤30 mm. Thermal ablation was associated with a higher 5-year CSM rate, compared with cryosurgery (7.6% 3.9%, = 0.02), but only when TS was >30 mm. TS >30 mm is an independent predictor of higher 5-year CSM rates in patients treated with LTA, even after adjustment for OCM rate. In consequence, when LTA is considered, it ideally should be performed for TS ≤30 mm.
在机构研究中，肿瘤大小（TS）可能是局部肿瘤消融（LTA）后复发的独立预测因素。然而，目前的数据有限，无法确定较大的 TS 是否也会导致癌症特异性死亡率（CSM）率升高。
在监测、流行病学和最终结果（SEER）数据库中确定了 2004 年至 2015 年接受 LTA 治疗的 T1a 期非转移性肾细胞癌患者。采用估计年百分比变化（EAPC）方法、累积发病率图和多变量竞争风险回归（CRR）模型，比较了 TS≤30mm 和 TS>30mm 的患者。还根据 TS 比较了冷冻手术和热消融治疗。
在 3946 例接受 LTA 的患者中，2974 例（75.3%）患者的 TS≤30mm，972 例（24.7%）患者的 TS>30mm。后者明显更老（中位年龄 67 岁和 71 岁，<0.001）。在无匹配的 CRR 模型中，在调整其他原因死亡率（OCM）率后，与 TS≤30mm 相比，TS>30mm 的 LTA 5 年 CSM 率更差（风险比 [HR]2.3，<0.001）。在 PS 和 OCM 率调整后的 CRR 模型中，与 TS≤30mm 相比，TS>30mm 的 LTA 5 年 CSM 率仍然更高（HR2.86，<0.001）。与冷冻手术相比，TS>30mm 时，热消融与更高的 5 年 CSM 率相关（7.6%比 3.9%，=0.02），但仅限于 TS>30mm。
TS>30mm 是接受 LTA 治疗的患者 5 年 CSM 率升高的独立预测因素，即使在调整 OCM 率后也是如此。因此，当考虑 LTA 时，理想情况下应在 TS≤30mm 时进行。
