Imaging Department, University College London Hospitals NHS Foundation Trust, London, United Kingdom.
Centre for Medical Imaging, University College London, 250 Euston Rd, London, NW1 2PG, United Kingdom.
AJR Am J Roentgenol. 2020 Jul;215(1):242-247. doi: 10.2214/AJR.19.22213. Epub 2020 Apr 14.
The purpose of this study was to evaluate the immediate and 3- and 5-year outcomes of patients with clinical stage T1 (cT1) biopsy-proven renal cell carcinoma (RCC) treated by image-guided percutaneous cryoablation at a regional interventional oncology center. A prospectively maintained local interventional radiology database identified patients with cT1 RCC lesions that were treated by percutaneous cryoablation. Technical success, procedural complications (graded using the Clavien-Dindo classification system), and the residual unablated tumor rate were collated. Local tumor progression-free survival was estimated using Kaplan-Meier estimates. A total of 180 patients with 185 separate cT1 RCC lesions were identified. Mean patient age was 68.4 years (range, 34.1-88.9 years) and 52 patients (28.9%) were women. There were 168 (90.8%) and 17 (9.2%) cT1a and cT1b lesions, respectively, with a mean lesion size of 28.5 mm (range, 11-58 mm). Technical success was achieved in 183 of 185 (98.9%) patients. The major complication rate (Clavien-Dindo classification ≥ grade III) was 2.2% (four out of 185). Residual unablated tumor on the first follow-up scan was identified in four of 183 tumors (2.2%). Estimated local tumor progression-free survival at 3 and 5 years was 98.3% and 94.9%, respectively. No distant metastases or deaths attributable to RCC occurred. Mean estimated glomerular filtration rate (eGFR) before the procedure was 72.4 ± 18.5 (SD) mL/min/1.73 m and this was not statistically significantly different after the procedure (69.7 ± 18.8 mL/min/1.73 m), at 1 year (70.7 ± 16.4 mL/min/1.73 m), or at 2 years (69.8 ± 18.9 mL/min/1.73 m) ( > 0.05). These data add to the accumulating evidence that image-guided cryoablation is an efficacious treatment for selected cT1 RCC with a low complication rate and ro bust 3- and 5-year outcomes.
本研究旨在评估在区域性介入肿瘤中心行影像引导经皮冷冻消融治疗临床 T1 期（cT1）经活检证实的肾细胞癌（RCC）患者的即刻和 3 年、5 年疗效。通过前瞻性维护的局部介入放射学数据库，确定了接受经皮冷冻消融治疗的 cT1 RCC 病变患者。收集了技术成功率、手术并发症（采用 Clavien-Dindo 分类系统分级）和残留未消融肿瘤率。采用 Kaplan-Meier 估计法估计局部肿瘤无进展生存率。
共确定了 180 例 185 个单独的 cT1 RCC 病变患者。患者平均年龄为 68.4 岁（范围 34.1-88.9 岁），52 例（28.9%）为女性。分别有 168 例（90.8%）和 17 例（9.2%）cT1a 和 cT1b 病变，病变平均大小为 28.5mm（范围 11-58mm）。185 例患者中 183 例（98.9%）达到技术成功。主要并发症发生率（Clavien-Dindo 分类≥3 级）为 2.2%（185 例中有 4 例）。在 183 个肿瘤中有 4 个（2.2%）在第一次随访扫描时发现有残留未消融肿瘤。3 年和 5 年的局部肿瘤无进展生存率分别为 98.3%和 94.9%。无归因于 RCC 的远处转移或死亡。术前估算肾小球滤过率（eGFR）为 72.4±18.5（SD）mL/min/1.73m，术后无统计学差异（69.7±18.8mL/min/1.73m），术后 1 年（70.7±16.4mL/min/1.73m）和术后 2 年（69.8±18.9mL/min/1.73m）（>0.05）。这些数据增加了越来越多的证据，表明影像引导冷冻消融是治疗选定的 cT1 RCC 的有效治疗方法，并发症发生率低，3 年和 5 年的结果可靠。
