Department of Radiology & Biomedical Imaging, University of California, San Francisco, California.
Department of Radiology & Biomedical Imaging, University of California, San Francisco, California.
J Vasc Interv Radiol. 2021 Apr;32(4):527-535.e1. doi: 10.1016/j.jvir.2020.12.010. Epub 2021 Jan 29.
To evaluate the efficacy and safety of percutaneous ablation of adrenal metastases through a meta-analysis of various image-guided percutaneous ablation techniques.
A comprehensive literature search of PubMed and Embase databases was performed for studies evaluating the efficacy and/or safety of image-guided percutaneous ablation of adrenal metastases. A total of 37 studies published between 2009 and 2020 were analyzed, comprising a sample size of 959 patients. Proportion estimates of overall survival, local control, and toxicity were analyzed in a pooled meta-analysis. The pooled prevalence of adverse events after ablation was calculated based on common terminology criteria for adverse events (CTCAE) grading.
Of the 959 included patients, 320 (33.3%) underwent radiofrequency ablation, 72 (7.5%) microwave ablation, 95 (9.9%) cryoablation, and 46 (4.8%) ethanol injections for treatment of adrenal metastases. The remaining 426 (44.4%) patients were from studies involving a mixture of the 4 listed percutaneous ablation techniques. The pooled 1-year local control rate was 80% (95% confidence interval [CI], 76%-83%). The pooled 1-year overall survival rate was 77% (95% CI, 70%-83%). The overall rate of severe adverse events after ablation (CTCAE grade 3 or higher) was 16.1%. The overall rate of low-grade adverse events after ablation (CTCAE grade 2 or lower) was 32.6%. Approximately 21.9% (n = 203) of patients experienced intraprocedural hypertensive crises, the majority of which were reversed with antihypertensive medications.
This study demonstrates that image-guided percutaneous ablation can be effective in achieving acceptable short- to mid-term local tumor control and overall survival with a moderate safety profile.
通过对各种影像引导下经皮消融技术的荟萃分析，评估经皮消融肾上腺转移瘤的疗效和安全性。
对 PubMed 和 Embase 数据库进行全面文献检索，评估影像引导下经皮消融肾上腺转移瘤的疗效和/或安全性的研究。共分析了 2009 年至 2020 年期间发表的 37 项研究，纳入了 959 例患者。采用荟萃分析对总生存率、局部控制率和毒性的比例进行评估。根据常见不良事件术语标准（CTCAE）分级，计算消融后不良事件的总发生率。
959 例患者中，320 例（33.3%）接受射频消融治疗，72 例（7.5%）接受微波消融治疗，95 例（9.9%）接受冷冻消融治疗，46 例（4.8%）接受乙醇注射治疗。其余 426 例（44.4%）患者来自涉及 4 种经皮消融技术混合的研究。荟萃分析的 1 年局部控制率为 80%（95%置信区间 [CI]，76%-83%）。1 年总生存率为 77%（95%CI，70%-83%）。消融后严重不良事件（CTCAE 分级 3 级或更高）的总发生率为 16.1%。消融后低级别不良事件（CTCAE 分级 2 级或更低）的总发生率为 32.6%。约 21.9%（n=203）的患者出现术中高血压危象，大多数患者经降压药物治疗后得到逆转。
本研究表明，影像引导下经皮消融治疗可有效实现可接受的短期至中期局部肿瘤控制和整体生存率，且具有中等安全性。
