Division of Urology, Department of Urology, IRCCS University Hospital of Bologna, Bologna, Italy -
University of Bologna, Bologna, Italy -
Minerva Urol Nephrol. 2021 Oct;73(5):581-590. doi: 10.23736/S2724-6051.20.03983-1. Epub 2020 Dec 1.
The aim, of this study was to investigate recurrence rates in patients with T1 renal cell carcinoma (RCC) undergone partial nephrectomy (PN), radiofrequency ablation (RFA) or cryoablation (Cryo).
We retrospectively evaluated data from 665 (81.4%), 68 (8.3%) and 83 (10.3%) patients who underwent PN, RFA and Cryo, respectively. Kaplan-Meier curves depict recurrence-free survival (RFS) rates in the overall population and after stratifying according to tumor's histology (namely, clear cell RCC and non-clear RCC) and size (namely <2 cm and 2-4 cm). Multivariable Cox regression model was used to identify predictors of recurrence. Cumulative-incidence plots evaluated disease recurrence and other causes of mortality (OCM).
Patients referred to PN experienced higher RFS rate compared to those treated with RFA and Cryo at 60-month in the overall population (96.4% vs. 79.4% vs. 87.8%), in patients with clear cell RCC (93.3% vs. 75% vs. 80.4%) and in those with tumor of 2-4 cm (97.3% vs. 78% and 84.4%; all P≤0.01). In patients with non-clear cell RCC and with tumor <2cm, PN showed higher RFS rate at 60-month as compared to RFA (97.9% vs. 84.4% and 95.1% vs. 78.1%, respectively: all P≤0.02). At multi-variate analysis, ablative techniques (RFA [HR=4.03] and Cryo [HR=3.86]) were independent predictors of recurrence (all P<0.03). At competing risks analysis, recurrence rate and OCM were 7.3% and 1.3% vs. 25% and 7.2% vs. 19.9% and 19.9% for PN, RFA and Cryo, respectively.
PN and Cryo showed similar RFS rates in patients with non-clear cell RCC and with renal mass <2cm.
本研究旨在调查接受部分肾切除术（PN）、射频消融术（RFA）或冷冻消融术（Cryo）治疗的 T1 肾细胞癌（RCC）患者的复发率。
我们回顾性评估了分别接受 PN、RFA 和 Cryo 治疗的 665（81.4%）、68（8.3%）和 83（10.3%）例患者的数据。Kaplan-Meier 曲线描绘了总体人群以及根据肿瘤组织学（即透明细胞 RCC 和非透明细胞 RCC）和大小（即<2cm 和 2-4cm）分层后的无复发生存率（RFS）。多变量 Cox 回归模型用于识别复发的预测因素。累积发生率图评估了疾病复发和其他死亡原因（OCM）。
总体人群中，接受 PN 治疗的患者 60 个月时的 RFS 率高于接受 RFA 和 Cryo 治疗的患者（96.4% vs. 79.4% vs. 87.8%），在透明细胞 RCC 患者中（93.3% vs. 75% vs. 80.4%）和肿瘤大小为 2-4cm 的患者中（97.3% vs. 78%和 84.4%；均 P≤0.01）。在非透明细胞 RCC 患者和肿瘤<2cm 的患者中，PN 在 60 个月时的 RFS 率高于 RFA（97.9% vs. 84.4%和 95.1% vs. 78.1%；均 P≤0.02）。多变量分析显示，消融技术（RFA [HR=4.03] 和 Cryo [HR=3.86]）是复发的独立预测因素（均 P<0.03）。在竞争风险分析中，PN、RFA 和 Cryo 的复发率和 OCM 分别为 7.3%和 1.3% vs. 25%和 7.2% vs. 19.9%和 19.9%。
PN 和 Cryo 在非透明细胞 RCC 患者和<2cm 肾肿瘤患者中显示出相似的 RFS 率。
