Cernic Stefano, Marrocchio Cristina, Ciabattoni Riccardo, Fiorese Ilaria, Stacul Fulvio, Giudici Fabiola, Rizzo Michele, Cova Maria Assunta
Department of Radiology, ASUGI, Ospedale di Cattinara, 30149 Trieste, Italy.
Department of Radiology, University of Trieste, ASUGI, Ospedale di Cattinara, 34149 Trieste, Italy.
Medicina (Kaunas). 2021 Mar 20;57(3):291. doi: 10.3390/medicina57030291.
Cryoablation is emerging as a safe and effective therapeutic option for treating renal cell carcinoma. This study analyzed the safety and long-term oncological outcomes of cryoablation in our center. Patients who underwent computed tomography (CT)-guided percutaneous cryoablation between February 2011 and June 2020 for one or more clinically localized renal tumors were identified. Technical success and treatment efficacy were assessed. Post-procedural complications were classified according to the Clavien-Dindo system. Recurrence-free survival was determined for biopsy-proven malignant renal tumors. A total of 174 renal tumors, 78 of which were biopsy-proven malignant carcinomas, were treated in 138 patients (97 males and 41 females, mean age: 73 years, range: 43-89 years). Mean tumor size was 2.25 cm and 54.6% of the lesions required a complex approach. Technical success was achieved in 171 out of 174 tumors (98.3%). Primary treatment efficacy was 95.3% and increased to 98.2% when retreats were taken into account. The overall complication rate was 29.8%. No complications of Clavien-Dindo grade III or more were encountered. Median follow-up was 21.92 months (range: 0.02-99.87). Recurrence-free survival was 100% at 1 year, 95.3% (95% CI: 82.1%-98.8%) at 3 years, and 88.6% (95% CI: 71.8%-95.7%) at 5 years. Cryoablation is a safe and effective technique for the treatment of small renal lesions, with no major complications when performed by expert interventional radiologists. The multidisciplinary discussion is essential, especially considering the high number of histologically undetermined lesions. Our long-term oncological outcomes are encouraging and in line with the literature.
冷冻消融正逐渐成为治疗肾细胞癌的一种安全有效的治疗选择。本研究分析了我院冷冻消融治疗的安全性和长期肿瘤学结局。确定了2011年2月至2020年6月期间因一个或多个临床局限性肾肿瘤接受计算机断层扫描（CT）引导下经皮冷冻消融的患者。评估技术成功率和治疗效果。术后并发症根据Clavien-Dindo系统进行分类。对经活检证实的恶性肾肿瘤确定无复发生存率。138例患者（97例男性和41例女性，平均年龄：73岁，范围：43 - 89岁）共治疗了174个肾肿瘤，其中78个经活检证实为恶性癌。平均肿瘤大小为2.25 cm，54.6%的病变需要采用复杂方法。174个肿瘤中有171个（98.3%）实现了技术成功。主要治疗有效率为95.3%，考虑再次治疗后升至98.2%。总体并发症发生率为29.8%。未遇到Clavien-Dindo III级或更高等级的并发症。中位随访时间为21.92个月（范围：0.02 - 99.87）。1年时无复发生存率为100%，3年时为95.3%（95%CI：82.1% - 98.8%），5年时为88.6%（95%CI：71.8% - 95.7%）。冷冻消融是治疗小肾病变的一种安全有效的技术，由专业介入放射科医生进行时无重大并发症。多学科讨论至关重要，尤其是考虑到组织学未确定病变的数量较多。我们的长期肿瘤学结局令人鼓舞且与文献一致。
