Aikawa Koichi, Yanagisawa Takafumi, Fukuokaya Wataru, Shimizu Kanichiro, Miyajima Keiichiro, Nakazono Minoru, Iwatani Kosuke, Matsukawa Akihiro, Obayashi Koki, Kimura Shoji, Tsuzuki Shunsuke, Sasaki Hiroshi, Abe Hirokazu, Sadaoka Shunichi, Miki Jun, Kimura Takahiro
Department of Urology, The Jikei University School of Medicine, Tokyo, Japan.
Department of Urology, The Jikei University School of Medicine, Tokyo, Japan.
Urol Oncol. 2023 Mar;41(3):150.e11-150.e19. doi: 10.1016/j.urolonc.2022.11.025. Epub 2023 Jan 4.
To investigate differential clinical outcomes in patients treated with partial nephrectomy (PN) vs. percutaneous cryoablation (PCA) for cT1b renal tumors.
We retrospectively analyzed the records of 119 patients who had undergone PN (n = 90) or PCA (n = 29) for cT1b renal tumors. Inverse probability weighting (IPW) was used for balancing patient demographics, including renal function and tumor complexity. Perioperative complications, renal function preservation rates, and oncological outcomes such as local recurrence-free, metastasis-free, cancer-specific, and overall survival were compared using IPW-adjusted restricted mean survival times (RMSTs).
PCA was more likely to be selected for octogenarians (odds ratio: 11.4, 95% confidence interval [CI]: 3.33-45.1). During the median follow-up of 43 months in the PCA group and 36.5 months in the PN group, unablated local residue or local recurrence was noted in 6 patients in the PCA group and local recurrence was noted in 4 patients in the PN groups. Of the 6 patients in the PCA group, 4 underwent salvage PCA, and local control had been achieved at the last visit. In the IPW-adjusted population, PCA had significantly worse local recurrence-free survival compared with PN (IPW-adjusted RMST difference: -22.7 months, 95% CI: -45.3 to -0.4, P = 0.046). IPW-adjusted RMST for metastasis-free survival (P = 0.23), cancer-specific survival (P = 0.77), and overall survival (P = 0.11) did not differ between PCA and PN. In addition, PN was not a predictor for local control failure at the last visit (odds ratio: 0.30, 95%CI: 0.05-1.29). There were no statistically significant differences between PN and PCA in renal function preservation or overall/severe complication rates.
In patients with cT1b renal tumor, although the local recurrence rate is higher for PCA than for PN, PCA provides comparable distant oncologic outcomes. PCA can be an alternative treatment option for elderly, comorbid patients, even those with cT1b renal tumors.
研究接受部分肾切除术（PN）与经皮冷冻消融术（PCA）治疗cT1b期肾肿瘤患者的临床结局差异。
我们回顾性分析了119例接受PN（n = 90）或PCA（n = 29）治疗cT1b期肾肿瘤患者的记录。采用逆概率加权法（IPW）平衡患者人口统计学特征，包括肾功能和肿瘤复杂性。使用IPW调整后的受限平均生存时间（RMST）比较围手术期并发症、肾功能保留率以及局部无复发生存率、无转移生存率、癌症特异性生存率和总生存率等肿瘤学结局。
PCA更有可能被八旬老人选择（优势比：11.4，95%置信区间[CI]：3.33 - 45.1）。PCA组中位随访43个月，PN组中位随访36.5个月，PCA组有6例患者出现未消融的局部残留或局部复发，PN组有4例患者出现局部复发。PCA组的6例患者中，4例接受了挽救性PCA，最后一次随访时已实现局部控制。在IPW调整后的人群中，与PN相比，PCA的局部无复发生存率显著更差（IPW调整后的RMST差异：-22.7个月，95%CI：-45.3至-0.4，P = 0.046）。PCA和PN在无转移生存率（P = 0.23）、癌症特异性生存率（P = 0.77）和总生存率（P = 0.11）的IPW调整后的RMST方面没有差异。此外PN不是最后一次随访时局部控制失败的预测因素（优势比：0.30，95%CI：0.05 - 1.29）。PN和PCA在肾功能保留或总体/严重并发症发生率方面没有统计学显著差异。
在cT1b期肾肿瘤患者中，尽管PCA的局部复发率高于PN，但PCA提供了相当的远处肿瘤学结局。PCA可以作为老年、合并症患者甚至cT1b期肾肿瘤患者的替代治疗选择。
