Qiu Jessica, Ballantyne Christopher, Yeaman Clint, Lange Moritz, Morgan John, Mershon J Patrick, Richie Iman, DeNovio Anthony, Clements Matthew B, Krupski Tracey L, Schenkman Noah, Lobo Jennifer M
University of Virginia School of Medicine, 1300 Jefferson Park Avenue, P.O. Box 800717, Charlottesville, VA, 22908-0717, USA.
Department of Urology, University of Virginia, Charlottesville, VA, USA.
Abdom Radiol (NY). 2023 Aug;48(8):2695-2704. doi: 10.1007/s00261-023-03935-9. Epub 2023 May 22.
To compare the oncological and renal function outcomes for patients receiving microwave ablation (MWA) in tumors < 3 and 3-4 cm.
Retrospective analysis of a prospectively maintained database identified patients with < 3 or 3-4 cm renal cancers undergoing MWA. Radiographic follow-up occurred at approximately 6 months post-procedure and annually thereafter. Serum creatinine and estimated glomerular filtration rate (eGFR) were calculated before and 6-months post-MWA. Local recurrence-free survival (LRFS) was estimated using the Kaplan-Meier method. Tumor size was evaluated as a prognostic factor using Cox proportional-hazards regression. Predictors for change in eGFR and chronic kidney disease (CKD) stage were modeled using linear and ordinal logistic regression.
A total of 126 patients fit the inclusion criteria. Overall recurrences were 2/62 (3.2%) and 6/64 (9.4%) for < 3 versus 3-4 cm. Both recurrences in the < 3 cm group were local, 4/6 in the 3-4 cm group were local and 2/6 were metastatic without local progression. For < 3 versus 3-4 cm, cumulative LRFS at 36 months was 94.6% versus 91.4%. Tumor size was not a significant prognostic factor for LRFS. Renal function did not change significantly after MWA. Patient comorbidities and RENAL nephrometry score significantly affected change in CKD.
With comparable oncological outcomes, complication rates, and renal function preservation, MWA is a promising management strategy for renal masses of 3-4 cm in select patients. Our findings suggest that current AUA guidelines, which recommend thermal ablation for tumors < 3 cm, may need review to include T1a tumors for MWA, regardless of size.
比较接受微波消融（MWA）治疗的肿瘤直径小于3 cm和3 - 4 cm患者的肿瘤学及肾功能结局。
对前瞻性维护的数据库进行回顾性分析，确定接受MWA治疗的直径小于3 cm或3 - 4 cm的肾癌患者。术后约6个月进行影像学随访，此后每年随访一次。在MWA术前及术后6个月计算血清肌酐和估计肾小球滤过率（eGFR）。采用Kaplan-Meier法估计局部无复发生存率（LRFS）。使用Cox比例风险回归评估肿瘤大小作为预后因素。使用线性和有序逻辑回归对eGFR变化及慢性肾脏病（CKD）分期的预测因素进行建模。
共有126例患者符合纳入标准。肿瘤直径小于3 cm组与3 - 4 cm组的总体复发率分别为2/62（3.2%）和6/64（9.4%）。直径小于3 cm组的2例复发均为局部复发，3 - 4 cm组的6例复发中4例为局部复发，2例为远处转移且无局部进展。对于直径小于3 cm与3 - 4 cm的患者，36个月时的累积LRFS分别为94.6%和91.4%。肿瘤大小不是LRFS的显著预后因素。MWA术后肾功能无显著变化。患者合并症及RENAL肾计量评分显著影响CKD的变化。
MWA在肿瘤学结局、并发症发生率及肾功能保留方面具有可比性，是部分患者中治疗直径3 - 4 cm肾肿瘤的一种有前景的治疗策略。我们的研究结果表明，目前美国泌尿外科学会（AUA）指南推荐对直径小于3 cm的肿瘤进行热消融，可能需要重新审视，将T1a期肿瘤纳入MWA治疗，无论其大小。
