热消融治疗小肾肿瘤：确定最合适的肿瘤大小截断值以预测围手术期和肿瘤学结局。
Thermal ablation for small renal masses: Identifying the most appropriate tumor size cut-off for predicting perioperative and oncological outcomes.
机构信息
Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy; Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, 20122, Milan, Italy.
Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy; Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, 20122, Milan, Italy.
出版信息
Urol Oncol. 2022 Dec;40(12):537.e1-537.e9. doi: 10.1016/j.urolonc.2022.08.008. Epub 2022 Oct 9.
OBJECTIVES
To test TRIFECTA achievement [1) absence of CLAVIEN-DINDO ≥3 complications; 2) complete ablation; 3) absence of ≥30% decrease in eGFR] and local recurrence rates, according to tumor size, in patients treated with thermal ablation (TA: radiofrequency [RFA] and microwave ablation [MWA]) for small renal masses.
METHODS
Retrospective analysis (2008-2020) of 432 patients treated with TA (RFA: 162 vs. MWA: 270). Tumor size was evaluated as: 1) continuously coded variable (cm); 2) tumor size strata (0.1-2 vs. 2.1-3 vs. 3.1-4 vs. >4 cm). Multivariable logistic regression models and a minimum P-value approach were used for testing TRIFECTA achievement. Kaplan-Meier plots depicted local recurrence rates over time.
RESULTS
Overall, 162 (37.5%) vs. 140 (32.4%) vs. 82 (19.0%) vs. 48 (11.1%) patients harboured, respectively, 0.1 to 2 vs. 2.1 to 3 vs. 3.1 to 4 vs. >4 cm tumors. In multivariable logistic regression models, increasing tumor size was associated with higher rates of no TRIFECTA achievement (OR:1.11; P< 0.001). Using a minimum P-value approach, an optimal tumor size cut-off of 3.2 cm was identified (P< 0.001). In multivariable logistic regression models, 3.1 to 4 cm tumors (OR:1.27; P< 0.001) and >4 cm tumors (OR:1.49; P< 0.001), but not 2.1 to 3 cm tumors (OR:1.05; P= 0.3) were associated with higher rates of no TRIFECTA achievement, relative to 0.1 to 2 cm tumors. The same results were observed in separate analyses of RFA vs. MWA patients. After a median (IQR) follow-up time of 22 (12-44) months, 8 (4.9%), 8 (5.7%), 11 (13.4%), and 5 (10.4%) local recurrences were observed in tumors sized 0.1 to 2 vs. 2.1 to 3 vs. 3.1 to 4 vs. >4 cm, respectively (P= 0.01).
CONCLUSION
A tumor size cut-off value of ≤3 cm is associated with higher rates of TRIFECTA achievement and lower rates of local recurrence over time in patients treated with TA for small renal masses.
目的
根据肿瘤大小，测试接受热消融（TA：射频[RFA]和微波消融[MWA]）治疗的小肾肿瘤患者的 TRIFECTA 实现[1）无 CLAVIEN-DINDO ≥3 并发症；2）完全消融；3）eGFR 下降≥30%）和局部复发率。
方法
回顾性分析（2008-2020 年）432 例接受 TA（RFA：162 例 vs. MWA：270 例）治疗的患者。肿瘤大小评估为：1）连续编码变量（cm）；2）肿瘤大小分层（0.1-2 vs. 2.1-3 vs. 3.1-4 vs. >4 cm）。使用多变量逻辑回归模型和最小 P 值方法检验 TRIFECTA 实现情况。Kaplan-Meier 图描绘了随时间推移的局部复发率。
结果
总体而言，分别有 162（37.5%）、140（32.4%）、82（19.0%）和 48（11.1%）例患者的肿瘤大小为 0.1-2、2.1-3、3.1-4 和 >4 cm。多变量逻辑回归模型显示，肿瘤大小增加与 TRIFECTA 实现率降低相关（OR：1.11；P<0.001）。使用最小 P 值方法，确定了 3.2 cm 的最佳肿瘤大小截断值（P<0.001）。多变量逻辑回归模型显示，3.1-4 cm 肿瘤（OR：1.27；P<0.001）和 >4 cm 肿瘤（OR：1.49；P<0.001），而不是 2.1-3 cm 肿瘤（OR：1.05；P=0.3），与 TRIFECTA 实现率降低相关，与 0.1-2 cm 肿瘤相比。在 RFA 与 MWA 患者的单独分析中观察到了相同的结果。在中位（IQR）随访时间 22（12-44）个月后，肿瘤大小为 0.1-2、2.1-3、3.1-4 和 >4 cm 的患者中分别观察到 8（4.9%）、8（5.7%）、11（13.4%）和 5（10.4%）例局部复发（P=0.01）。
结论
在接受 TA 治疗小肾肿瘤的患者中，肿瘤大小≤3 cm 与 TRIFECTA 实现率较高和局部复发率较低相关。
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