Enikeev Dmitry, Morozov Andrey, Bazarkin Andrey, Shpikina Anastasia, Brill Boris, Teoh Jeremy Y, Suvorov Aleksandr, Singla Nirmish, Taratkin Mark, Rivas Juan G, Barret Eric
Department of Urology, Medical University of Vienna, Vienna, Austria -
Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia -
Minerva Urol Nephrol. 2023 Apr;75(2):154-162. doi: 10.23736/S2724-6051.22.05036-4. Epub 2023 Feb 17.
Partial nephrectomy, thermal ablation and active surveillance are acceptable options for T1 stage renal tumor management. Currently, we lack sufficient information to make an accurate comparison of thermal ablation with active surveillance. The study objectives were to compare thermal ablation with active surveillance indirectly using partial nephrectomy as a reference.
We performed a systematic literature search using two databases (Scopus and Medline). The detailed search strategy is available at Prospero, CRD42021290055. The primary outcome was cancer-specific survival. Secondary outcomes included overall survival and metastasis-free survival.
The final sample comprised 33 articles. They included the ones that compare: partial nephrectomy to ablation (29 studies), partial nephrectomy to active surveillance (2 studies), and partial nephrectomy vs. active surveillance vs. ablation (2 articles). We assessed 3-year and 5-year cancer-specific survival, and 3-, 5- and 7-year overall survival. The surface under the cumulative ranking curve (SUCRA) treatment benefit ranking was: cancer-specific survival - 48.6% for thermal ablation and 1.6% for active surveillance (5-year follow-up); overall survival - 52% for thermal ablation and 0.6% for active surveillance (7-year follow-up). The results demonstrated a significantly higher 3-year cancer-specific survival (RR 1.55, P=0.02) and 3- and 7-year follow-up overall survival (RR 1.85, P=0.03) in thermal ablation compared to active surveillance. At 5-year follow-up, cancer-specific survival and overall survival were in favor of thermal ablation while no statistically significant difference was reported.
Thermal ablation offers a significantly higher cancer-specific survival and overall survival at mid-term follow-up in the management of T1 renal tumors compared to active surveillance. However, it is necessary to conduct further prospective randomized studies to validate the data.
对于T1期肾肿瘤的治疗，部分肾切除术、热消融术和主动监测是可接受的选择。目前，我们缺乏足够的信息来对热消融术和主动监测进行准确比较。本研究的目的是通过以部分肾切除术作为参照，间接比较热消融术和主动监测。
我们使用两个数据库（Scopus和Medline）进行了系统的文献检索。详细的检索策略可在国际前瞻性注册系统（Prospero）中获取，注册号为CRD42021290055。主要结局是癌症特异性生存率。次要结局包括总生存率和无转移生存率。
最终纳入样本的有33篇文章。它们包括比较以下内容的文章：部分肾切除术与消融术（29项研究）、部分肾切除术与主动监测（2项研究）以及部分肾切除术对比主动监测与消融术（2篇文章）。我们评估了3年和5年的癌症特异性生存率，以及3年、5年和7年的总生存率。累积排名曲线下面积（SUCRA）治疗获益排名为：癌症特异性生存率——热消融术为48.6%，主动监测为1.6%（5年随访）；总生存率——热消融术为52%，主动监测为0.6%（7年随访）。结果表明，与主动监测相比，热消融术的3年癌症特异性生存率显著更高（风险比1.55，P = 0.02），以及3年和7年随访的总生存率显著更高（风险比1.85，P = 0.03）。在5年随访时，癌症特异性生存率和总生存率倾向于热消融术，但未报告有统计学显著差异。
与主动监测相比，在T1期肾肿瘤的治疗中，热消融术在中期随访时具有显著更高的癌症特异性生存率和总生存率。然而，有必要进行进一步的前瞻性随机研究以验证这些数据。
