Cancer Prognostics and Health Outcomes Unit, University of Montreal Hospital Center, Montreal, Quebec, Canada.
Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano.
J Urol. 2019 Dec;202(6):1120-1126. doi: 10.1097/JU.0000000000000460. Epub 2019 Jul 26.
Cryoablation is done in select patients with pT1b nonmetastatic renal cell carcinoma without convincing proof of efficacy. Our aim was to test for differences in the cancer specific mortality rate for cryoablation and partial nephrectomy in T1b nonmetastatic renal cell carcinoma cases.
In the 2004 to 2015 SEER (Surveillance, Epidemiology, and End Results) database we identified 5,763 patients with a T1b tumor treated with cryoablation or partial nephrectomy. Modeling relied on multivariable logistic regression models predicting cryoablation vs partial nephrectomy. After 1:2 ratio propensity score matching between patients treated with cryoablation vs partial nephrectomy we used cumulative incidence plot and competing risks regression to test differences in cancer specific mortality and other cause mortality rates.
Relative to the 5,521 patients who underwent partial nephrectomy the 242 treated with cryoablation were older, had smaller tumors and more frequently harbored unclassified renal cell carcinoma of low or unknown grade. Median followup was 38 months. In multivariable logistic regression models predicting cryoablation vs partial nephrectomy more advanced patient age was an independent predictor (OR 1.03; p=0.007). After propensity score matching and other cause mortality adjustment the 5-year cancer specific mortality rate was 2.5-fold higher after cryoablation than after partial nephrectomy (p=0.03). Conversely after propensity score matching and cancer specific mortality adjustment the 5-year other cause mortality rate was similar to that of partial nephrectomy after cryoablation (HR 1.45, p=0.12). The major limitation of this study was the lack of recurrence and metastatic progression data.
The current findings demonstrated a 2.5-fold increase in cancer specific mortality when cryoablation was performed in patients with pT1b renal cell carcinoma. This observation should be interpreted as a contraindication to cryoablation outside clinical trials or institutional protocols.
在没有明确疗效证据的情况下，选择患有 pT1b 期非转移性肾细胞癌的患者进行冷冻消融术。我们的目的是检测冷冻消融术和部分肾切除术治疗 T1b 期非转移性肾细胞癌患者的癌症特异性死亡率是否存在差异。
在 2004 年至 2015 年 SEER（监测、流行病学和最终结果）数据库中，我们确定了 5763 例接受冷冻消融术或部分肾切除术治疗的 T1b 肿瘤患者。模型依赖于预测冷冻消融术与部分肾切除术的多变量逻辑回归模型。对接受冷冻消融术与部分肾切除术的患者进行 1:2 比例的倾向评分匹配后，我们使用累积发生率图和竞争风险回归来检测癌症特异性死亡率和其他原因死亡率的差异。
与 5521 例接受部分肾切除术的患者相比，242 例接受冷冻消融术的患者年龄更大，肿瘤更小，且更常存在未分类的低级别或未知分级的肾细胞癌。中位随访时间为 38 个月。在预测冷冻消融术与部分肾切除术的多变量逻辑回归模型中，患者年龄的增加是独立的预测因素（OR 1.03；p=0.007）。在进行倾向评分匹配和其他原因死亡率调整后，冷冻消融术 5 年癌症特异性死亡率比部分肾切除术高 2.5 倍（p=0.03）。相反，在进行倾向评分匹配和癌症特异性死亡率调整后，冷冻消融术 5 年其他原因死亡率与部分肾切除术相似（HR 1.45，p=0.12）。本研究的主要局限性是缺乏复发和转移进展数据。
目前的研究结果表明，冷冻消融术治疗 pT1b 期肾细胞癌患者时，癌症特异性死亡率增加了 2.5 倍。这一观察结果应被视为在临床试验或机构方案之外进行冷冻消融术的禁忌症。
