School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, England, UK.
Department of Urology, St. James's University Hospital, Leeds, UK.
Eur Radiol. 2022 Sep;32(9):5811-5820. doi: 10.1007/s00330-022-08719-1. Epub 2022 Apr 6.
To compare long-term outcomes and peri-operative outcomes of image-guided ablation (IGA) and laparoscopic partial nephrectomy (LPN).
This is a retrospective cohort study of localised RCC (T1a/bN0M0) patients undergoing cryoablation (CRYO), radio-frequency ablation (RFA), or LPN at our institution from 2003 to 2016. Oncological outcomes were compared using Cox regression and log-rank analysis. eGFR changes were compared using Kruskal-Wallis and Wilcoxon-rank tests.
A total of 296 (238 T1a, 58 T1b) consecutive patients were identified; 103, 100, and 93 patients underwent CRYO, RFA, and LPN, respectively. Median follow-up time was 75, 98, and 71 months, respectively. On univariate analysis, all oncological outcomes were comparable amongst CRYO, RFA, and LPN (p > 0.05). On multivariate analysis, T1a patients undergoing RFA had improved local recurrence-free survival (LRFS) (HR 0.002, 95% CI 0.00-0.11, p = 0.003) and metastasis-free survival (HR 0.002, 95% CI 0.00-0.52, p = 0.029) compared to LPN. In T1a and T1b patients combined, both CRYO (HR 0.07, 95% CI 0.01-0.73, p = 0.026) and RFA (HR 0.04, 95% CI 0.03-0.48, p = 0.011) had improved LRFS rates. Patients undergoing CRYO and RFA had a significantly smaller median decrease in eGFR post-operatively compared to LPN (T1a: p < 0.001; T1b: p = 0.047). Limitations include retrospective design and limited statistical power.
IGA is potentially as good as LPN in oncological durability. IGA preserves kidney function significantly better than LPN. More studies with larger sample size should be performed to establish IGA as a first-line treatment alongside LPN.
• Ablative therapies are alternatives to partial nephrectomy for managing small renal cell carcinomas. • This study reports long-term outcomes of image-guided ablation versus partial nephrectomy. • Ablative therapies have comparable oncological durability and better renal function preservation compared to partial nephrectomy.
比较影像引导消融（IGA）与腹腔镜部分肾切除术（LPN）的长期疗效和围手术期疗效。
本研究为回顾性队列研究，纳入了于 2003 年至 2016 年在我院接受冷冻消融（CRYO）、射频消融（RFA）或 LPN 治疗的局限性 RCC（T1a/bN0M0）患者。采用 Cox 回归和对数秩分析比较肿瘤学结果。采用 Kruskal-Wallis 和 Wilcoxon 秩检验比较 eGFR 变化。
共纳入 296 例（238 例 T1a，58 例 T1b）连续患者；103、100 和 93 例患者分别接受了 CRYO、RFA 和 LPN 治疗。中位随访时间分别为 75、98 和 71 个月。单因素分析显示，CRYO、RFA 和 LPN 之间的所有肿瘤学结果均无显著差异（p＞0.05）。多因素分析显示，RFA 治疗的 T1a 患者局部无复发生存率（LRFS）（HR 0.002，95%CI 0.00-0.11，p=0.003）和无转移生存率（HR 0.002，95%CI 0.00-0.52，p=0.029）优于 LPN。在 T1a 和 T1b 患者中，CRYO（HR 0.07，95%CI 0.01-0.73，p=0.026）和 RFA（HR 0.04，95%CI 0.03-0.48，p=0.011）的 LRFS 率均有所提高。与 LPN 相比，接受 CRYO 和 RFA 治疗的患者术后 eGFR 中位数下降幅度明显较小（T1a：p＜0.001；T1b：p=0.047）。局限性包括回顾性设计和有限的统计能力。
IGA 在肿瘤学耐久性方面可能与 LPN 一样好。IGA 显著优于 LPN 保留肾功能。应进行更多具有更大样本量的研究，以确立 IGA 作为与 LPN 并列的一线治疗方法。
•消融疗法是治疗小肾癌的部分肾切除术的替代方法。•本研究报告了影像引导消融与部分肾切除术的长期疗效。•与部分肾切除术相比，消融疗法具有相似的肿瘤学耐久性和更好的肾功能保留。
