经皮微波消融与腹腔镜部分肾切除术治疗 cT1a 期肾癌：1955 例患者的倾向性匹配队列研究。
Percutaneous Microwave Ablation versus Laparoscopic Partial Nephrectomy for cT1a Renal Cell Carcinoma: A Propensity-matched Cohort Study of 1955 Patients.
机构信息
From the Department of Interventional Ultrasound (J.Y., X.Y., Z.C., Z.H., F.L., G.H., M.M., P.L.), State Key Laboratory of Kidney Disease (J.Y., P.L), and Department of Urology Surgery (X.Z.), Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China; Department of Cardiovascular Surgery, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China (H.L.); and Department of Urology, the Fourth Hospital of Baotou, Baotou, Inner Mongolia, China (R.Z.).
出版信息
Radiology. 2020 Mar;294(3):698-706. doi: 10.1148/radiol.2020190919. Epub 2020 Jan 21.
Background Percutaneous microwave ablation (MWA) and laparoscopic partial nephrectomy (LPN) are two modalities indicated for early-stage renal cell carcinoma (RCC) with low extent of invasion. Purpose To compare the long-term results of percutaneous MWA and LPN in the treatment of cT1a RCC. Materials and Methods This retrospective study included 1955 patients with cT1a RCC treated with percutaneous MWA or LPN between April 2006 and November 2017. Propensity score matching was used. Oncologic outcomes were analyzed by using the Fine-and-Gray competing risk models. Results A total of 185 patients underwent percutaneous MWA (mean age, 63.2 years ± 15.2 [standard deviation]) and 1770 underwent LPN (mean age, 50.9 years ± 13.2). During the follow-up (median, 40.6 months), after propensity score matching, no difference was observed between local tumor progression (3.2% vs 0.5%, = .10), cancer-specific survival (2.2% vs 3.8%, = .24), and distant metastases (4.3% vs 4.3%, = .76). Patients who underwent percutaneous MWA had worse overall survival (hazard ratio, 2.4; 95% confidence interval: 1.0, 5.7; = .049 vs LPN) and disease-free survival (82.9% vs 91.4%, = .003). Percutaneous MWA led to smaller drop in estimated glomerular filtration rate at discharge (6.2% vs 16.4%, < .001), smaller estimated blood loss (4.5 mL ± 1.3 vs 54.2 mL ± 69.2), lower cost ($3150 ± 2970 vs $6045 ± 1860 U.S. dollars), shorter operative time (0.5 minute ± 0.1 vs 1.8 minutes ± 0.6), and shorter postoperative hospitalization time (5.1 days ± 2.6 vs 6.9 days ± 2.8) (all < .001 vs LPN). There were fewer cases of fever in the percutaneous MWA group (16.2% vs 73.0%, < .001). Conclusion There were no significant differences regarding oncologic outcomes and complications between percutaneous microwave ablation and laparoscopic partial nephrectomy for patients with cT1a renal cell carcinoma. Percutaneous microwave ablation led to smaller renal function change and lower blood loss. For patients who cannot be subjected to the risks of more invasive laparoscopic partial nephrectomy, percutaneous microwave ablation could be an alternative less invasive treatment option. © RSNA, 2020
背景 经皮微波消融（MWA）和腹腔镜部分肾切除术（LPN）是两种用于治疗早期局限性肾细胞癌（RCC）且侵袭程度较低的方法。目的 比较经皮 MWA 和 LPN 治疗 cT1a RCC 的长期结果。材料与方法 本回顾性研究纳入了 2006 年 4 月至 2017 年 11 月期间接受经皮 MWA 或 LPN 治疗的 1955 例 cT1a RCC 患者。采用倾向评分匹配法。使用 Fine-and-Gray 竞争风险模型分析肿瘤学结果。结果 共有 185 例患者接受经皮 MWA（平均年龄，63.2 岁±15.2[标准差]），1770 例患者接受 LPN（平均年龄，50.9 岁±13.2）。在随访（中位时间，40.6 个月）期间，经倾向评分匹配后，局部肿瘤进展（3.2%比 0.5%， =.10）、癌症特异性生存率（2.2%比 3.8%， =.24）和远处转移率（4.3%比 4.3%， =.76）无差异。接受经皮 MWA 的患者总生存率（风险比，2.4；95%置信区间：1.0，5.7； =.049 比 LPN）和无病生存率（82.9%比 91.4%， =.003）更差。经皮 MWA 导致出院时估算肾小球滤过率下降更小（6.2%比 16.4%， <.001）、估算出血量更小（4.5 毫升±1.3 比 54.2 毫升±69.2 毫升）、费用更低（3150 美元±2970 美元比 6045 美元±1860 美元）、手术时间更短（0.5 分钟±0.1 比 1.8 分钟±0.6）、术后住院时间更短（5.1 天±2.6 比 6.9 天±2.8）（均 <.001 比 LPN）。经皮 MWA 组发热病例更少（16.2%比 73.0%， <.001）。结论 在 cT1a 肾细胞癌患者中，经皮 MWA 和 LPN 的肿瘤学结果和并发症无显著差异。经皮 MWA 导致肾功能变化更小、出血量更少。对于不能承受更具侵袭性的腹腔镜部分肾切除术风险的患者，经皮 MWA 可能是一种替代的微创治疗选择。
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