Division of Urology, Massey Cancer Center, VCU Health, Richmond, Virginia, USA.
Department of Neurosciences, Reproductive Sciences and Odontostomatology, Urology Unit, University of Naples "Federico II," Napoli, Italy.
J Endourol. 2023 Mar;37(3):279-285. doi: 10.1089/end.2022.0478. Epub 2022 Nov 29.
To compare outcomes of robot-assisted partial nephrectomy (RAPN) and percutaneous tumor ablation (PTA) for completely endophytic renal masses. Data of patients who underwent RAPN or PTA for treatment of completely endophytic (three points for "E" domain of R.E.N.A.L. score) were collected from seven high-volume U.S. and European centers. PTA included cryoablation, radiofrequency, or microwave ablation. Baseline characteristics, clinical, surgical, and postoperative outcomes were compared. Recurrence-free survival (RFS) was calculated with Kaplan-Meier analysis. Trifecta was used as arbitrary combined outcome parameter as proxy for treatment "quality." Multivariable logistic regression model assessed predictors of trifecta failure. One hundred fifty-two patients (RAPN, = 60; PTA, = 92) were included in the analysis. RAPN group was younger ( < 0.001), had lower American Society of Anesthesiologists score ( = 0.002), and higher baseline estimated glomerular filtration rate ( < 0.001). There was no difference in clinical tumor size, clinical T stage, and tumor complexity scores. PTA had significantly lower rate of overall ( < 0.001) and minor ( < 0.001) complications. ΔeGFR at 1 year was statistically higher for RAPN (-15.5 mL/min -3.1 mL/min; = 0.005), no difference in ΔeGFR at last follow-up ( = 0.22) was observed. No difference in recurrences (RAPN, = 2; PTA, = 6) and RFS was found ( = 0.154). Trifecta achievement was higher for RAPN but not statistically different (65.3% 58.8%; = 0.477). R.E.N.A.L. Nephrometry Score resulted predictive of trifecta failure (odds ratio = 1.47; confidence interval = 1.13-1.90; = 0.004). PTA confirms to be an effective treatment for completely endophytic renal masses, offering low complications and good mid-term functional and oncologic outcomes. These outcomes compare favorably with those of RAPN, which seem to be the preferred option for younger and less comorbid patients.
比较机器人辅助部分肾切除术（RAPN）和经皮肿瘤消融术（PTA）治疗完全内生性肾肿瘤的结果。从美国和欧洲的七个高容量中心收集了接受 RAPN 或 PTA 治疗完全内生性（RENAL 评分的“E”域为 3 分）的患者的数据。PTA 包括冷冻消融、射频或微波消融。比较了基线特征、临床、手术和术后结果。用 Kaplan-Meier 分析计算无复发生存率（RFS）。将 trifecta 用作治疗“质量”的任意综合结果参数。多变量逻辑回归模型评估 trifecta 失败的预测因素。 152 名患者（RAPN，n=60；PTA，n=92）纳入分析。RAPN 组年龄较小（<0.001），美国麻醉师协会评分较低（=0.002），基线估算肾小球滤过率较高（<0.001）。临床肿瘤大小、临床 T 分期和肿瘤复杂性评分无差异。PTA 的总并发症（<0.001）和轻微并发症（<0.001）发生率明显较低。RAPN 的 1 年 eGFR 下降（-15.5ml/min-3.1ml/min；=0.005）统计学上更高，最后一次随访时 eGFR 下降无差异（=0.22）。未发现复发（RAPN，n=2；PTA，n=6）和 RFS 差异（=0.154）。RAPN 的 trifecta 达成率较高，但无统计学差异（65.3% 58.8%；=0.477）。RENAL 肾肿瘤测量评分是 trifecta 失败的预测因素（优势比=1.47；置信区间=1.13-1.90；=0.004）。 PTA 被证实是治疗完全内生性肾肿瘤的有效方法，具有低并发症和良好的中期功能和肿瘤学结果。这些结果与 RAPN 的结果相当，RAPN 似乎是年轻和合并症较少患者的首选。
