Department of Urology, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel.
Department of Urology, Cabueñes Hospital, Gijón, Spain.
Eur Urol Oncol. 2020 Aug;3(4):433-452. doi: 10.1016/j.euo.2020.02.001. Epub 2020 Mar 31.
The European Association of Urology (EAU) Renal Cell Carcinoma (RCC) Guideline Panel performed a protocol-driven systematic review (SR) on thermal ablation (TA) compared with partial nephrectomy (PN) for T1N0M0 renal masses, in order to provide evidence to support its recommendations. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed, and only comparative studies published between 2000 and 2019 were included. Twenty-six nonrandomised comparative studies were included, recruiting a total of 167 80 patients. Risk of bias (RoB) assessment revealed high or uncertain RoB across all studies, with the vast majority being retrospective, observational studies with poorly matched controls and short follow-up. Limited data showed TA to be safe, but its long-term oncological effectiveness compared with PN remains uncertain. A quality assessment of pre-existing SRs (n=11) on the topic, using AMSTAR, revealed that all SRs had low confidence rating, with all but two SRs being rated critically low. In conclusion, the current data are inadequate to make any strong and clear conclusions regarding the clinical effectiveness of TA for treating T1N0M0 renal masses compared with PN. Therefore, TA may be cautiously considered an alternative to PN for T1N0M0 renal masses, but patients must be counselled carefully regarding the prevailing uncertainties. We recommend specific steps to improve the evidence base based on robust primary and secondary studies. PATIENT SUMMARY: In this report, we looked at the literature to determine the effectiveness of thermoablation (TA) in the treatment of small kidney tumours compared with surgical removal. We found that TA could cautiously be offered as an option due to many remaining uncertainties regarding its effectiveness.
欧洲泌尿外科学会（EAU）肾癌（RCC）指南小组针对 T1N0M0 肾肿瘤的热消融（TA）与部分肾切除术（PN）进行了基于方案的系统评价（SR），以提供支持其建议的证据。遵循了系统评价和荟萃分析的首选报告项目（PRISMA）指南，并且仅纳入了 2000 年至 2019 年期间发表的比较研究。共纳入了 26 项非随机比较研究，共招募了 16780 名患者。风险偏倚（RoB）评估显示，所有研究的 RoB 均较高或不确定，其中绝大多数为回顾性、观察性研究，对照匹配较差，随访时间短。有限的数据表明 TA 是安全的，但与 PN 相比，其长期肿瘤学效果仍不确定。使用 AMSTAR 对该主题的 11 项现有 SR 进行质量评估，结果显示所有 SR 的可信度评分均较低，除了两项 SR 外，其余均被评为极低。总之，目前的数据不足以对 TA 治疗 T1N0M0 肾肿瘤与 PN 相比的临床效果做出任何有力和明确的结论。因此，TA 可能可以谨慎地被视为 T1N0M0 肾肿瘤的 PN 替代方案，但必须向患者详细说明当前存在的不确定性。我们建议根据稳健的一级和二级研究来提高证据基础的具体步骤。患者总结：在本报告中，我们查阅了文献，以确定热消融（TA）在治疗小肾癌方面与手术切除相比的有效性。我们发现，由于其有效性仍存在许多不确定性，因此可以谨慎地将 TA 作为一种选择。
