Department of Radiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.
Cardiovasc Intervent Radiol. 2020 Jul;43(7):1025-1033. doi: 10.1007/s00270-020-02423-7. Epub 2020 Feb 12.
To assess the safety and efficacy of percutaneous microwave ablation (MWA) of histologically proven T1 renal cell carcinoma (RCC).
We analysed patients with a histologically proven RCC (≤ 7 cm) treated by MWA from April 2012-April 2018. Primary and secondary efficacy, local tumour recurrence (LTR), morbidity and mortality were reported. Efficacy was defined as no residual tumour enhancement on follow-up imaging 1 month after the first ablation (primary efficacy) and after re-ablation(s) for residual disease (secondary efficacy). Adverse events (AE) were registered by the Clavien-Dindo classification and the common terminology criteria for AE. Univariable and multivariable logistic regression analyses were performed to investigate a relation among pre-treatment factors incomplete ablation and complications.
In 100 patients, a total of 108 RCCs (85 T1a and 23 T1b) were treated by MWA. Median size was 3.2 cm (IQR 2.4-4.0). Primary efficacy was 89% (95%CI 0.81-0.94) for T1a lesions and 52% (95%CI 0.31-0.73) for T1b lesions (p < 0.001). Fifteen lesions (7 T1a) were re-ablated for residual disease by MWA in one (n = 13) and two (n = 2, both T1b) sessions resulting in secondary efficacy rates of 99% (T1a) and 95% (T1b, p = 0.352). LTR occurred in four tumours (2 T1a, 2 T1b) after 10-60 months. Six (4%) AEs grade > 3-5 were observed (2 T1a, 4 T1b, p = 0.045). Multivariable analysis showed that mR.E.N.A.L. nephrometry was independently associated with incomplete ablation (p = 0.012).
Microwave ablation is safe and effective for T1a and T1b RCC lesions with a significantly lower primary efficacy for T1b lesions.
评估经皮微波消融（MWA）治疗组织学证实的 T1 期肾细胞癌（RCC）的安全性和疗效。
我们分析了 2012 年 4 月至 2018 年 4 月期间接受 MWA 治疗的组织学证实的 RCC（≤7cm）患者。报告了主要和次要疗效、局部肿瘤复发（LTR）、发病率和死亡率。疗效定义为首次消融后 1 个月随访成像时无残留肿瘤增强（主要疗效）以及对残留疾病进行再消融后的疗效（次要疗效）。通过 Clavien-Dindo 分类和常见术语标准对不良事件（AE）进行登记。进行单变量和多变量逻辑回归分析以研究治疗前因素（不完全消融）与并发症之间的关系。
在 100 例患者中，共治疗了 108 个 RCC（85 个 T1a 和 23 个 T1b）。中位大小为 3.2cm（IQR 2.4-4.0）。T1a 病变的主要疗效为 89%（95%CI 0.81-0.94），T1b 病变为 52%（95%CI 0.31-0.73）（p<0.001）。15 个病灶（7 个 T1a）因残留病灶而接受 MWA 再消融，1 次（n=13）和 2 次（n=2，均为 T1b），主要疗效分别为 99%（T1a）和 95%（T1b，p=0.352）。4 个肿瘤（2 个 T1a，2 个 T1b）在 10-60 个月后发生 LTR。观察到 6 例（4%）AE 分级>3-5（2 例 T1a，4 例 T1b，p=0.045）。多变量分析显示，mR.E.N.A.L. 肾脏肿瘤学与不完全消融独立相关（p=0.012）。
MWA 治疗 T1a 和 T1b RCC 病变是安全有效的，T1b 病变的主要疗效显著降低。
