Duus Louise A, Junker Theresa, Rasmussen Benjamin S, Bojsen Jonas A, Pedersen Allan L, Anthonsen Andrea, Lund Lars, Pedersen Michael, Graumann Ole
Department of Radiology, 11286Odense University Hospital (OUH), Odense C, Denmark.
Research and Innovation Unit of Radiology, 6174University of Southern Denmark (SDU), Odense C, Denmark.
Acta Radiol. 2023 Feb;64(2):814-820. doi: 10.1177/02841851221081825. Epub 2022 Mar 17.
Cryoablation is a promising minimally invasive, nephron-sparing treatment of small renal carcinoma (RCC) in co-morbid patients.
To assess the safety, efficacy, and cancer-specific outcomes of computed tomography (CT)-guided cryoablation of stage T1 (RCC).
A retrospective evaluation of 122 consecutive patients with 128 tumors treated with cryoablation during 2016-2017. All patients had biopsy-verified T1 RCC.
Median age was 69 years (IQR=59-76); 69% were male. Median tumor size was 26 mm (± 20-33); 9% were stage T1b. Mean follow-up time was 36.3±12.0 months. In total, 14 (11%) procedures led to complications, of which 4 (3%) were intraoperative, 5 (4%) appeared ≤30 days and 5 (4%) >30 days after treatment. Major complications arose after 4 (3%) procedures. Statistically significant associations were found between major complications and stage T1b ( = 0.039), RENAL score ( = 0.010), and number of needles used in cryoablation ( = 0.004). Residual tumor was detected after 4 (3%) procedures and 5 (4%) tumors had local tumor progression. Of 122 patients, 3 (2%) advanced to metastatic disease. Significant statistical associations were found between local tumor progression and T1b stage tumors and number of needles used in cryoablation ( = 0.05 and = 0.004, respectively). For patients with T1a tumors, the one- and three-year disease-free survival was 98% and 95%, respectively, and for T1b 100% after one year and 75% after three years.
This study showed that cryoablation is a safe and effective treatment of stage T1 RCC and suggests that in selecting candidates for cryoablation of RCC, the tumor characteristics are more critical than patients' baseline health status.
冷冻消融是一种有前景的微创、保留肾单位的治疗合并症患者小肾癌（RCC）的方法。
评估计算机断层扫描（CT）引导下T1期（RCC）冷冻消融的安全性、有效性和癌症特异性结局。
回顾性评估2016年至2017年期间连续122例接受128次肿瘤冷冻消融治疗的患者。所有患者均经活检证实为T1期RCC。
中位年龄为69岁（四分位间距=59-76）；69%为男性。中位肿瘤大小为26 mm（±20-33）；9%为T1b期。平均随访时间为36.3±12.0个月。总共有14例（11%）手术导致并发症，其中4例（3%）为术中并发症，5例（4%）在治疗后≤30天出现，5例（4%）在治疗后>30天出现。4例（3%）手术出现严重并发症。在严重并发症与T1b期（=0.039）、RENAL评分（=0.010）以及冷冻消融所用针数（=0.004）之间发现有统计学意义的关联。4例（3%）手术检测到残留肿瘤，5例（4%）肿瘤出现局部肿瘤进展。122例患者中，3例（2%）进展为转移性疾病。在局部肿瘤进展与T1b期肿瘤以及冷冻消融所用针数之间发现有显著的统计学关联（分别为=0.05和=0.004）。对于T1a期肿瘤患者，1年和3年无病生存率分别为98%和95%，对于T1b期肿瘤患者，1年后为100%，3年后为75%。
本研究表明冷冻消融是T1期RCC的一种安全有效的治疗方法，并表明在选择RCC冷冻消融候选者时，肿瘤特征比患者的基线健康状况更为关键。
