Department of Urology, University of Texas Southwestern, Dallas, Texas, USA.
Department of Urology, University of Iowa, Iowa City, Iowa, USA.
J Endourol. 2021 Nov;35(11):1586-1592. doi: 10.1089/end.2021.0115. Epub 2021 Aug 18.
Irreversible electroporation (IRE) is a nonthermal ablative technology that applies high-voltage short-pulse electrical current to create cellular membrane nanopores and ultimately results in apoptosis. This is thought to overcome thermal limitations of other ablative technologies. We report 5-year oncologic outcomes of percutaneous IRE for small renal masses. A single-institution retrospective review of cT1a renal masses treated with IRE from April 2013 to December 2019 was performed. Those with <1 month follow-up were excluded. IRE was performed with the NanoKnife System (Angiodynamics, Latham, NY). Renal mass biopsy was obtained before or during ablation in most circumstances; biopsy was excluded in some patients because of concern for IRE probe displacement. Postablation guideline-based surveillance imaging was performed. Initial treatment failure was defined as persistent tumor enhancement on first post-treatment imaging. Survival analysis was performed through the Kaplan-Meier method for effectively treated tumors (SPSS; IBM, Armonk, NY). IRE was used to treat 48 tumors in 47 patients. Twenty-two per 48 tumors (45.8%) were biopsy-confirmed renal cell carcinoma (RCC). No complications ≥ Clavien Grade III occurred and 36 patients (76.6%) were discharged the same day. Initial treatment success rate was 91.7% ( = 44/48); three treatment failures were managed with salvage radiofrequency ablation and one with robotic partial nephrectomy. Median follow-up was 50.4 months (interquartile range 29.0-65.5). The 5-year local recurrence-free survival was 81.4% in biopsy-confirmed RCC patients and 81.0% in all patients. Five-year metastasis-free survival was 93.3% and 97.1%, respectively, and 5-year overall survival was 92.3% and 90.6%, respectively. Five-year cancer-specific survival was 100% for both biopsy-confirmed RCC and all patient groups. IRE has low morbidity, but suboptimal intermediate-term oncologic outcomes compared with conventional thermal ablation techniques for small low-complexity tumors. Use of IRE should be restricted to select cases.
不可逆电穿孔（IRE）是一种非热消融技术，它应用高电压短脉冲电流来创建细胞膜纳米孔，最终导致细胞凋亡。这被认为克服了其他消融技术的热限制。我们报告了经皮 IRE 治疗小肾肿瘤的 5 年肿瘤学结果。
对 2013 年 4 月至 2019 年 12 月期间采用 IRE 治疗的 cT1a 肾肿瘤进行了单机构回顾性研究。排除了随访时间<1 个月的患者。IRE 采用 NanoKnife 系统（Angiodynamics，Latham，NY）进行。在大多数情况下，在消融前或消融过程中获得肾肿瘤活检；由于担心 IRE 探针移位，一些患者排除了活检。消融后基于指南的监测成像。首次治疗后影像学上持续肿瘤增强定义为初始治疗失败。通过 Kaplan-Meier 方法对有效治疗的肿瘤进行生存分析（SPSS；IBM，Armonk，NY）。
IRE 用于治疗 47 名患者的 48 个肿瘤。22 个肿瘤中有 48 个（45.8%）活检证实为肾细胞癌（RCC）。没有发生≥Clavien 3 级的并发症，36 名患者（76.6%）当天出院。初始治疗成功率为 91.7%（44/48）；3 例治疗失败采用补救性射频消融治疗，1 例采用机器人部分肾切除术治疗。中位随访时间为 50.4 个月（四分位距 29.0-65.5）。活检证实的 RCC 患者和所有患者的 5 年局部无复发生存率分别为 81.4%和 81.0%。5 年无转移生存率分别为 93.3%和 97.1%，5 年总生存率分别为 92.3%和 90.6%。活检证实的 RCC 患者和所有患者组的 5 年癌症特异性生存率均为 100%。
IRE 具有低发病率，但与小而低复杂性肿瘤的常规热消融技术相比，其中期肿瘤学结果并不理想。IRE 的使用应限于选择病例。
