From the Departments of Interventional Radiology.
Urology, University Hospital of Strasbourg, Strasbourg, France.
Invest Radiol. 2021 Mar 1;56(3):153-162. doi: 10.1097/RLI.0000000000000719.
Magnetic resonance imaging guidance has been sporadically reported for renal tumor cryoablation (CA); therefore, clinical experience with this modality is still limited.The aim of this study is to retrospectively analyze our 10-year experience with renal tumor CA performed on a 1.5 T magnetic resonance imaging unit with the intent of reporting procedural safety and oncologic outcomes.
We included 143 patients (102 men; 41 women; median age, 73 years; range, 34-91 years) with 149 tumors (median size, 2.6 cm; range, 0.6-6.0 cm), treated between 2009 and 2019. Patient, tumor, procedure, and follow-up data were collected and analyzed. The Kaplan-Meier method was used to estimate local recurrence-free (LRFS), metastasis-free (MFS), disease-free (DFS), cancer-specific, and overall (OS) survival. Univariate and multivariate models were used to identify factors associated with complications, LRFS, MFS, DFS, and OS.
The overall complication rate was 10.7% (16/149 tumors), with 1 major (1/149 [0.7%]; 95% confidence interval, 0.0%-3.7%) hemorrhagic complication. Other minor complications (15/149 [10.1%]; 95% confidence interval, 0.6%-16.1%) did not include any cases of injury to nearby organs. There were no factors associated with complications.Five-year estimates of LRFS (primary/secondary), MFS, DFS, cancer-specific survival, and OS were 82.8%/91.5%, 91.1%, 75.1%, 98.2%, and 89.6%, respectively. Increasing tumor size (hazard radio [HR], 1.8; P = 0.02) and intraparenchymal tumor location (HR, 5.6; P < 0.01) were associated with lower LRFS; increasing patient's age (HR, 0.5; P = 0.01), high tumor grade (HR, 23.3; P < 0.01) and non-clear-cell/nonpapillary histology (HR, 20.1; P < 0.01) with metastatic disease; and high tumor grade (HR, 3.2; P = 0.04) with lower DFS.
Magnetic resonance imaging-guided CA of renal tumors is associated with acceptable morbidity and high survival estimates at 5-year follow-up. Given the absence of complications resulting from injuries to nearby organs, further studies are required to evaluate whether the potential reduced incidence of these adverse events justifies large-scale implementation of this interventional modality.
磁共振成像（MRI）引导已零星报道用于肾肿瘤冷冻消融（CA）；因此，临床应用经验仍然有限。本研究旨在回顾性分析我们在 1.5T MRI 设备上进行肾肿瘤 CA 的 10 年经验，旨在报告程序安全性和肿瘤学结果。
我们纳入了 143 名患者（102 名男性；41 名女性；中位年龄 73 岁；范围 34-91 岁）和 149 个肿瘤（中位大小 2.6cm；范围 0.6-6.0cm），治疗时间为 2009 年至 2019 年。收集并分析患者、肿瘤、手术和随访数据。采用 Kaplan-Meier 法估计局部无复发生存率（LRFS）、无转移生存率（MFS）、无病生存率（DFS）、癌症特异性生存率和总生存率（OS）。采用单因素和多因素模型分析与并发症、LRFS、MFS、DFS 和 OS 相关的因素。
总体并发症发生率为 10.7%（16/149 个肿瘤），其中 1 例（1/149 [0.7%]；95%置信区间，0.0%-3.7%）为严重出血并发症。其他轻微并发症（15/149 [10.1%]；95%置信区间，0.6%-16.1%）不包括任何邻近器官损伤的病例。无并发症相关因素。5 年 LRFS（原发性/继发性）、MFS、DFS、癌症特异性生存率和 OS 的估计值分别为 82.8%/91.5%、91.1%、75.1%、98.2%和 89.6%。肿瘤大小增加（危险比 [HR]，1.8；P = 0.02）和肿瘤位于实质内（HR，5.6；P < 0.01）与较低的 LRFS 相关；患者年龄增加（HR，0.5；P = 0.01）、肿瘤分级高（HR，23.3；P < 0.01）和非透明细胞/非乳头状组织学（HR，20.1；P < 0.01）与转移性疾病相关；肿瘤分级高（HR，3.2；P = 0.04）与较低的 DFS 相关。
MRI 引导的肾肿瘤 CA 与可接受的发病率相关，5 年随访时生存率较高。鉴于无邻近器官损伤导致的并发症，需要进一步研究以评估这些不良事件发生率降低是否证明这种介入方式的大规模实施是合理的。
