2004年至2021年在某专科中心对冯·希佩尔-林道综合征患者肾癌进行多模态图像引导消融治疗：一项纵向观察性研究。

Multimodal image-guided ablation on management of renal cancer in Von-Hippel-Lindau syndrome patients from 2004 to 2021 at a specialist centre: A longitudinal observational study.

作者信息

Chan Vinson Wai-Shun, Lenton James, Smith Jonathan, Jagdev Satinder, Ralph Christy, Vasudev Naveen, Bhattarai Selina, Lewington Andrew, Kimuli Michael, Cartledge Jon, Wah Tze Min

机构信息

School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, LS2 9JT, United Kingdom.

Division of Diagnostic and Interventional Radiology, Institute of Oncology, St. James's University Hospital, Beckett Street, Leeds, LS9 7TF, United Kingdom.

出版信息

Eur J Surg Oncol. 2022 Mar;48(3):672-679. doi: 10.1016/j.ejso.2021.10.022. Epub 2021 Oct 28.

DOI:10.1016/j.ejso.2021.10.022

PMID:34728141

Abstract

OBJECTIVES

To analyse the safety, technical feasibility, long-term renal function and oncological outcome of multimodal technologies in image-guided ablation (IGA) for renal cancer in Von-Hippel-Lindau (VHL) patients, and to evaluate factors that may influence the outcome.

METHODS

Retrospective analysis of a prospective database of VHL patients who underwent IGA at a specialist centre. Patient's demographics, treatment energy, peri-operative outcome and oncological outcomes were recorded. Statistical analysis was performed to determine factors associated with complication and renal function reduction. The overall, 5 and 10-year cancer specific (CS), local recurrence-free (LRF) and metastasis-free (MF) survival rates were presented with Kaplan-Meier Curves.

RESULTS

From 2004 to 2021, 17 VHL patients (age 21-68.2) with a mean (±SD) RCC size of 2.06 ± 0.92 cm received IGA. Median (IQR) RCCs per patient was 3 (2-4) over the course of follow up. Fifty-four RCCs were treated using radiofrequency ablation (n = 11), cryoablation (n = 38) and irreversible electroporation (n = 8) in 50 sessions. Primary and overall technical success rate were 94.4% (51/54) and 98% (53/54). One CD-III complication with proximal ureteric injury. Five patients in seven treatment sessions experienced a >25% reduction of eGFR immediately post-IGA. All patients have preservation of renal function at a median follow-up of 79 (51-134) months. The 5 and 10-year CS, LRF and MF survival rates are 100%, 97.8% and 100%. Whilst, the 5 and 10-year overall survival rate are100% and 90%.

CONCLUSION

Multimodal IGA of de novo RCC for VHL patients is safe and has provided long term preservation of renal function and robust oncological durability.

摘要

目的

分析多模态技术在图像引导下对冯·希佩尔-林道（VHL）病患者肾癌进行消融治疗（IGA）的安全性、技术可行性、长期肾功能及肿瘤学结局，并评估可能影响结局的因素。

方法

对在一家专科中心接受IGA治疗的VHL病患者的前瞻性数据库进行回顾性分析。记录患者的人口统计学资料、治疗能量、围手术期结局及肿瘤学结局。进行统计学分析以确定与并发症及肾功能降低相关的因素。采用Kaplan-Meier曲线呈现总体、5年及10年癌症特异性（CS）、无局部复发（LRF）及无转移（MF）生存率。

结果

2004年至2021年，17例VHL病患者（年龄21 - 68.2岁）接受了IGA治疗，肾细胞癌（RCC）平均（±标准差）大小为2.06±0.92 cm。在随访过程中，每位患者的RCC中位数（四分位间距）为3（2 - 4）个。50个疗程中，54个RCC采用射频消融（n = 11）、冷冻消融（n = 38）和不可逆电穿孔（n = 8）进行治疗。主要技术成功率和总体技术成功率分别为94.4%（51/54）和98%（53/54）。发生1例Ⅲ级并发症，近端输尿管损伤。7个治疗疗程中的5例患者在IGA治疗后即刻eGFR降低>25%。在中位随访79（51 - 134）个月时，所有患者肾功能均得以保留。5年及10年的CS、LRF和MF生存率分别为100%、97.8%和100%。同时，5年及10年的总生存率分别为100%和90%。