经活检证实的 T1 期肾细胞癌行冷冻消融治疗的长期疗效。
Long-term outcomes of cryoablation for biopsy-proven T1 stage renal cell carcinoma.
机构信息
Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200011, China.
Fudan University Shanghai Cancer Center, Shanghai, 200032, China.
出版信息
World J Surg Oncol. 2022 Sep 6;20(1):284. doi: 10.1186/s12957-022-02752-6.
BACKGROUND
To summarize our clinical experience of cryoablation in renal cell carcinoma (RCC) of Chinese population and to evaluate the long-term outcomes of laparoendoscopic single-site (LESS) cryoablation (LCA) as well as percutaneous CT-guided cryoablation (PCA) for biopsy-proven T1a and T1b RCC.
METHODS
This was a multi-center, retrospective study investigating T1 stage RCC patients from 2011 to 2021. The patients were treated by LCA or PCA according to individual situation. Overall survival (OS), cancer-related survival (CSS), and progression-free survival (PFS) were evaluated for oncological outcomes, and kidney function, complications, and hospital stay were used to estimate technical outcomes.
RESULTS
A total of 163 consecutive patients were included. Among them, 59 cases were treated by LCA and PCA was performed in 104 cases. All operations were processed successfully. Mean diameter of the mass was (2.9±1.4) cm; median blood volume was 45ml (10200 ml). The mean operation time was 84.0 ± 24.5 min. The median postoperative hospital stay was 3 days (16 days). Compared with LCA, procedure time of PCA was shortened, the volume of bleeding was reduced, and the hospital stay was decreased. The overall adverse events rate was 9.8% (16/163). The mean preoperative and postoperative eGFR of LCA were 77.6±15.3 ml/min and 75.6±17.4 ml/min, respectively. Analogously, the values of PCA were 78.7±12.9 ml/min and 76.7±14.3 ml/min. Mean follow-up time was 64.2 ± 30.2 months (range, 7-127 months). Local recurrence was observed in 13 patients (8.0%), 4 (6.8%) cases of LCA and 9 (8.7%) cases of PCA. PFS at 5 and 10 years were 95.5% and 69.2% for LCA and 96.7% and 62.8% for PCA. In total, 26 patients (16.0%) (11 patients from LCA and 15 from PCA) died throughout the follow-up period. OS at 5 and 10 years were 93.8% and 31.4% for LCA, and 97.4% and 52.7% for PCA. Six patients (3.7%) (3 cases from LCA and 3 from PCA) died of metastatic RCC. CCS for LCA were 98.0% and 82.8% at 5 and 10 years, while the data were 100% and 86.4% for PCA.
CONCLUSION
LCA and PCA for T1 stage RCC provides satisfactory long-term oncological and renal function preservation outcomes, with acceptable complication rates.
背景
总结中国人群肾细胞癌（RCC）冷冻消融的临床经验，评估经腹腔镜单部位（LESS）冷冻消融（LCA）和经皮 CT 引导冷冻消融（PCA）治疗活检证实的 T1a 和 T1b RCC 的长期疗效。
方法
这是一项多中心回顾性研究，纳入 2011 年至 2021 年的 T1 期 RCC 患者。根据患者具体情况，采用 LCA 或 PCA 治疗。评估总生存（OS）、癌症相关生存（CSS）和无进展生存（PFS）的肿瘤学结局，以及肾功能、并发症和住院时间的技术结局。
结果
共纳入 163 例连续患者。其中，59 例采用 LCA 治疗，104 例采用 PCA 治疗。所有手术均顺利完成。肿块的平均直径为（2.9±1.4）cm；中位出血量为 45ml（10200ml）。平均手术时间为 84.0±24.5min。中位术后住院时间为 3 天（16 天）。与 LCA 相比，PCA 的手术时间更短，出血量更少，住院时间更短。整体不良事件发生率为 9.8%（16/163）。LCA 的术前和术后肾小球滤过率（eGFR）分别为 77.6±15.3ml/min 和 75.6±17.4ml/min，PCA 的相应值分别为 78.7±12.9ml/min 和 76.7±14.3ml/min。平均随访时间为 64.2±30.2 个月（7~127 个月）。13 例（8.0%）患者出现局部复发，4 例（6.8%）LCA 和 9 例（8.7%）PCA。LCA 和 PCA 的 5 年和 10 年 PFS 分别为 95.5%和 69.2%和 96.7%和 62.8%。随访期间共有 26 例（16.0%）（11 例来自 LCA，15 例来自 PCA）患者死亡。LCA 的 5 年和 10 年 OS 分别为 93.8%和 31.4%，PCA 的相应值分别为 97.4%和 52.7%。6 例（3.7%）（3 例来自 LCA，3 例来自 PCA）患者死于转移性 RCC。LCA 的 5 年和 10 年 CSS 分别为 98.0%和 82.8%，PCA 的相应值分别为 100%和 86.4%。
结论
LCA 和 PCA 治疗 T1 期 RCC 可获得满意的长期肿瘤学和肾功能保留效果，并发症发生率可接受。
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