Department of Urology, University Hospital Of Strasbourg, 1place de l'Hôpital, Strasbourg, France.
Department of Urology, University Hospital Of Strasbourg, 1place de l'Hôpital, Strasbourg, France.
Urol Oncol. 2020 Oct;38(10):797.e15-797.e20. doi: 10.1016/j.urolonc.2020.07.020. Epub 2020 Aug 7.
To report managing renal tumors in patients at greater risk of repeated interventions (genetic predisposition, multifocal tumors) with thermoablative treatments (AT). A known significant challenge in these patients is the balance between nephron preservation and oncologic outcome.
This retrospective, single-center study was based on data from patients treated with one or more AT for hereditary or multifocal renal tumors between 2007 and 2017. All medical records were systematically reviewed, and 10 patients meeting inclusion criteria were selected. Six patients had confirmed von Hippel-Lindau disease, 1 Bird-Hogg-Dubé syndrome, 1 chromosome 3 translocation, and 2 had a presumed genetic predisposition.
Median age at cancer diagnosis was 39.5 years (±8.9). Fifty-seven tumors, including 41 de novo tumors that appeared during follow-up, were treated with 32 AT sessions (cryotherapy or radiofrequency) with an average tumor size of 13.5 mm (±9) and a median RENAL score of 6 [5; 7]. One patient underwent concomitant partial nephrectomy for a 55 mm lesion which was close to the bowel. Treatment was unsuccessful in 2 cases, subsequently managed successfully by retreatment with AT. Median delay of appearance of de novo tumor after the first AT was 18 months [6 ; 24]. One patient had metastatic progression. Overall and cancer specific survival was 90% and 100%, respectively, with a mean follow-up of 7.5 years (±4.9). The mean decrease in Chronic Kidney Disease - Epidemiological Collaboration equation-estimated glomerular filtration rate at the end of follow-up was 5.5 ml/min/1.73 m (±24).
This study suggests that AT allows to meet the oncological objectives whilst preserving renal function in patients with renal cancer at greater risk of repeated treatments.
报告对具有复发性干预风险（遗传易感性、多灶性肿瘤）的患者采用热消融（AT）治疗管理肾肿瘤的经验。在这些患者中，一个已知的重要挑战是在保留肾单位和肿瘤学结果之间取得平衡。
本回顾性单中心研究基于 2007 年至 2017 年间接受一种或多种 AT 治疗遗传性或多灶性肾肿瘤的患者数据。对所有病历进行系统回顾，选择符合纳入标准的 10 例患者。6 例患者确诊为 von Hippel-Lindau 病，1 例 Bird-Hogg-Dubé 综合征，1 例染色体 3 易位，2 例有遗传性倾向。
诊断癌症时的中位年龄为 39.5 岁（±8.9）。57 个肿瘤，包括 41 个在随访期间出现的新发肿瘤，接受了 32 次 AT 治疗（冷冻或射频），平均肿瘤大小为 13.5mm（±9），中位 RENAL 评分为 6[5；7]。1 例患者因靠近肠的 55mm 病变而行同期部分肾切除术。2 例治疗无效，随后成功行 AT 再治疗。首次 AT 后新发肿瘤出现的中位延迟时间为 18 个月[6；24]。1 例患者出现转移性进展。总生存率和癌症特异性生存率分别为 90%和 100%，中位随访时间为 7.5 年（±4.9）。随访结束时慢性肾脏病流行病学合作组方程估算肾小球滤过率平均下降 5.5ml/min/1.73m（±24）。
本研究表明，在具有复发性治疗风险的肾细胞癌患者中，AT 既能满足肿瘤学目标，又能保留肾功能。
