Department of Radiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
Department of Radiology, Amsterdam University Medical Center Location VU, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
Eur Radiol. 2023 Feb;33(2):1040-1049. doi: 10.1007/s00330-022-09110-w. Epub 2022 Sep 6.
Percutaneous radiofrequency ablation (RFA) is stated as a treatment option for renal cell carcinoma (RCC) smaller than 4 cm (T1a). Microwave ablation (MWA) is a newer technique and is still considered experimental in some guidelines. The objective of this study was to compare the safety and efficacy of RFA and MWA for the treatment of RCC.
Patients with T1a RCC treated by RFA or MWA in two referral centers were retrospectively analyzed. Patient records were evaluated to generate mRENAL nephrometry scores. Local tumor progression (LTP) was considered when new (recurrence) or residual tumor enhancement within/adjacent to the ablation zone was objectified. Differences in LTP-free interval (residual + recurrence) between ablation techniques were assessed with Cox proportional hazards models and propensity score (PS) methods.
In 164 patients, 87 RFAs and 101 MWAs were performed for 188 RCCs. The primary efficacy rate was 92% (80/87) for RFA and 91% (92/101) for MWA. Sixteen patients had residual disease (RFA (n = 7), MWA (n = 9)) and 9 patients developed recurrence (RFA (n = 7), MWA (n = 2)). LTP-free interval was significantly worse for higher mRENAL nephrometry scores. No difference in LTP-free interval was found between RFA and MWA in a model with inverse probability weighting using PS (HR = 0.99, 95% CI 0.35-2.81, p = 0.98) and in a PS-matched dataset with 110 observations (HR = 0.82, 95% CI 0.16-4.31, p = 0.82). Twenty-eight (14.9%) complications (Clavien-Dindo grade I-IVa) occurred (RFA n = 14, MWA n = 14).
Primary efficacy for ablation of RCC is high for both RFA and MWA. No differences in efficacy and safety were observed between RFA and MWA.
• Both RFA and MWA are safe and effective ablation techniques in the treatment of T1a renal cell carcinomas. • High modified RENAL nephrometry scores are associated with shorter local tumor progression-free interval. • MWA can be used as heat-based ablation technique comparable to RFA for the treatment of T1a renal cell carcinomas.
经皮射频消融（RFA）被认为是治疗小于 4cm（T1a）的肾细胞癌（RCC）的一种治疗选择。微波消融（MWA）是一种较新技术，在一些指南中仍被认为是实验性的。本研究的目的是比较 RFA 和 MWA 治疗 RCC 的安全性和疗效。
对在两个转诊中心接受 RFA 或 MWA 治疗的 T1a RCC 患者进行回顾性分析。评估患者记录以生成 mRENAL 肾肿瘤评分。当消融区域内/附近出现新的（复发）或残留肿瘤增强时，认为发生局部肿瘤进展（LTP）。使用 Cox 比例风险模型和倾向评分（PS）方法评估消融技术之间的 LTP 无间隔（残留+复发）差异。
在 164 名患者中，对 188 个 RCC 进行了 87 次 RFA 和 101 次 MWA。RFA 的主要疗效率为 92%（80/87），MWA 为 91%（92/101）。16 名患者有残留疾病（RFA（n=7），MWA（n=9）），9 名患者出现复发（RFA（n=7），MWA（n=2））。mRENAL 肾肿瘤评分较高的患者 LTP 无间隔时间明显更差。在使用 PS 进行逆概率加权的模型中，RFA 和 MWA 之间的 LTP 无间隔时间无差异（HR=0.99，95%CI 0.35-2.81，p=0.98），在包含 110 个观察值的 PS 匹配数据集（HR=0.82，95%CI 0.16-4.31，p=0.82）中也无差异。28 例（14.9%）（Clavien-Dindo 分级 I-IVa）发生并发症（RFA n=14，MWA n=14）。
RFA 和 MWA 消融治疗 RCC 的主要疗效均较高。RFA 和 MWA 之间未观察到疗效和安全性差异。
RFA 和 MWA 均为治疗 T1a 肾细胞癌的安全有效的消融技术。
改良的 RENAL 肾肿瘤评分较高与较短的局部肿瘤进展无间隔时间相关。
MWA 可作为与 RFA 相比用于治疗 T1a 肾细胞癌的基于热的消融技术。
