Departments of Radiology and Urology, Weill Cornell Medical College, New York, NY.
EVERSANA, Burlington, Ontario, Canada.
Urology. 2023 Oct;180:1-8. doi: 10.1016/j.urology.2023.06.001. Epub 2023 Jun 17.
To conduct a systematic review and meta-analysis comparing microwave ablation (MWA) and cryoablation for renal cell carcinoma (RCC).
The systematic search was performed in MEDLINE, Embase, and Cochrane databases. Studies published in English from January 2006 to February 2022 that assessed adults with primary RCC who received MWA or cryoablation were included. Study arms from RCTs, comparative observational, and single-arm studies were eligible. The outcomes included local tumor recurrence (LTR), overall survival, disease-free survival, overall/major complications, procedure/ablation time, 1- to 3-month primary technique efficacy, and technical success. Single-arm meta-analyses were performed using the random effects model. Sensitivity analyses excluding low-quality studies assessed using the MINORs scale were performed. Univariable and multivariable examined the effects of prognostic factors.
Baseline characteristics were similar between groups and mean tumor size for MWA and cryoablation were 2.74 and 2.69 cm. Single-arm meta-analyses were similar for LTR and secondary outcomes between cryoablation and MWA. Ablation time was significantly shorter with MWA than with cryoablation (meta-regression weighted mean difference 24.55 minutes, 95% confidence interval -31.71, -17.38, P < .0001). One-year LTR was significantly lower with MWA than cryoablation (odds ratio 0.33, 95% confidence interval 0.10-0.93, P = .04). There were no significant differences for other outcomes.
MWA provides significantly improved 1-year LTR and ablation time compared with cryoablation for patients with RCC. Other outcomes appeared similar or favorable for MWA; however, results were not statistically significant. MWA of primary RCC is as safe and effective as cryoablation, which should be confirmed with future comparative studies.
对微波消融（MWA）和冷冻消融治疗肾细胞癌（RCC）进行系统评价和荟萃分析。
在 MEDLINE、Embase 和 Cochrane 数据库中进行系统检索。纳入 2006 年 1 月至 2022 年 2 月期间评估接受 MWA 或冷冻消融治疗的原发性 RCC 成人患者的英文发表研究。随机对照试验（RCT）、比较观察性研究和单臂研究的研究臂符合条件。结局包括局部肿瘤复发（LTR）、总生存、无病生存、总体/主要并发症、手术/消融时间、1-3 个月主要技术疗效和技术成功率。采用随机效应模型对单臂进行荟萃分析。采用 MINORs 量表评估排除低质量研究后的敏感性分析。单变量和多变量检查了预后因素的影响。
两组的基线特征相似，MWA 和冷冻消融的平均肿瘤大小分别为 2.74cm 和 2.69cm。冷冻消融和 MWA 的单臂荟萃分析结果在 LTR 和次要结局方面相似。MWA 的消融时间明显短于冷冻消融（荟萃回归加权平均差值 24.55 分钟，95%置信区间-31.71，-17.38，P<.0001）。MWA 组 1 年 LTR 明显低于冷冻消融组（比值比 0.33，95%置信区间 0.10-0.93，P=0.04）。其他结局无显著差异。
与冷冻消融相比，MWA 为 RCC 患者提供了显著改善的 1 年 LTR 和消融时间。其他结局似乎对 MWA 有利或相似；然而，结果没有统计学意义。MWA 治疗原发性 RCC 与冷冻消融一样安全有效，这需要通过未来的比较研究来证实。
