Urological Research Unit, Department of Urology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
Department of Radiology, Centre of Diagnostic Investigations, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
Scand J Urol. 2021 Jun;55(3):203-208. doi: 10.1080/21681805.2021.1900386. Epub 2021 Mar 19.
To evaluate the safety and efficacy of percutaneous CT-guided radiofrequency ablation (RFA) for small renal masses (SRMs) at a large single-institution center during a period of 12 years.
A total of 118 patients underwent RFA for SRM between July 2006 and July 2018 at our institution. We included demographic information, comorbidity, procedural details, and oncological outcome in the analysis. Survival analysis was performed using competing risk.
87 males and 31 females with median age 66 years underwent RFA. Median tumor size was 23 mm. Tumor biopsy was performed in 94% of cases, of which 56% were confirmed renal cell carcinoma (RCCs). Twenty-eight patients had benign tumors or underwent treatment for recurrence of prior RCC. Median follow-up of 5 years. Median Charlson Comorbidity Index was 5. Major complications occurred in 1.7%. No change in kidney function was observed. The initial treatment response was 98%. Among patients treated for newly diagnosed radiological suspected RCC without Von Hippel-Lindau or benign biopsy (90 pts), the cumulative incidence of radiological recurrence after 5 and 10 years was 6.6% (95% CI: 0.8-12%) and 16% (95% CI: 4.2-28%), respectively. Three patients died of RCC during follow-up. The cumulative incidence of kidney cancer death was 4.5% (95% CI: 4.3-13%) after 10 years. The incidence of other-cause mortality was 50% (95% CI: 34-67%).
CT-guided RFA is a safe and effective treatment option for patients unsuitable for surgery. RFA is a good alternative to partial or radical nephrectomy for SRMs, although randomized trials comparing surgery to minimally invasive thermal ablation techniques are missing.
在一家大型单中心机构，评估 12 年来经皮 CT 引导下射频消融（RFA）治疗小肾肿瘤（SRM）的安全性和有效性。
2006 年 7 月至 2018 年 7 月，我们机构共对 118 例 SRM 患者行 RFA 治疗。我们对患者的人口统计学信息、合并症、手术细节和肿瘤学结果进行了分析。采用竞争风险进行生存分析。
118 例患者中 87 例为男性，31 例为女性，中位年龄为 66 岁。肿瘤中位直径为 23mm。94%的病例进行了肿瘤活检，其中 56%为确诊的肾细胞癌（RCC）。28 例患者为良性肿瘤或因 RCC 复发而接受治疗。中位随访时间为 5 年。中位 Charlson 合并症指数为 5。主要并发症发生率为 1.7%。肾功能无变化。初始治疗反应率为 98%。在因新诊断的影像学可疑 RCC 而未行 Von Hippel-Lindau 或良性活检的患者中（90 例），5 年和 10 年后的影像学复发累积发生率分别为 6.6%（95%CI：0.8-12%）和 16%（95%CI：4.2-28%）。3 例患者在随访期间死于 RCC。10 年后，死于肾癌的累积发生率为 4.5%（95%CI：4.3-13%）。其他原因死亡率为 50%（95%CI：34-67%）。
CT 引导下 RFA 是不适合手术的患者的一种安全有效的治疗选择。RFA 是治疗 SRM 的部分或根治性肾切除术的良好替代方法，尽管缺乏比较手术与微创热消融技术的随机试验。
