Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Division of Urology, Department of Surgery, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada.
J Endourol. 2023 Dec;37(12):1314-1330. doi: 10.1089/end.2023.0342. Epub 2023 Nov 10.
Percutaneous microwave ablation (MWA) has emerged as a new energy modality for percutaneous renal tumor ablation with potential advantages over radiofrequency and cryoablation. The goal of our study was to determine MWA outcomes for suspicious renal masses, with a subset analysis for biopsy-proven renal cell carcinoma (RCC) and larger (T1b) tumors. Studies reporting outcomes of MWA for RCC were identified. Random-effects models with inverse-variance weighting were used to pool outcomes, including technical success rate (TSR), technical efficacy rate (TER), local recurrence rate (LRR), cancer-specific survival rate (CSSR), overall survival rate (OSR), and complications. Among 914 studies captured, 27 studies with 1584 patients (1683 malignant renal tumors) were included. The pooled TSR and TER were 99.6% (95% confidence interval [CI], 98.0%-100%) and 96.2% (95% CI, 93.8%-98.2%). The pooled LRR was 3.2% (95% CI, 1.9%-4.7%). At 1, 3, and 5 years, the pooled CSSRs were 100% (95% CI, 99.4%-100%), 100% (95% CI, 98.4%-100%), and 97.7% (95% CI, 94.5%-99.7%), while pooled OSRs were 99.0% (95% CI, 97.5%-99.9%), 96.0% (95% CI, 93.1%-98.3%), and 88.1% (95% CI, 80.3%-94.2%). The pooled minor and major complication rates were 10.3% (95% CI, 7.1%-13.9%) and 1.0% (95% CI, 0.3%-2.1%). In 204 patients with 208 T1b tumors, the pooled TSR and TER were 100% (95% CI, 96.6%-100%) and 85.2% (95% CI, 71.0%-95.8%). The pooled LRR was 4.2% (95% CI, 0.9%-8.9%). At 1, 3, and 5 years, the pooled CSSRs were 98.2% (95% CI, 88.7%-100%), 97.2% (95% CI, 78.5%-100%), and 98.1% (95% CI, 72.3%-100%). At 1 and 3 years, the pooled OSRs were 94.3% (95% CI, 85.7%-99.6%) and 89.3% (95% CI, 68.7%-100%). The pooled minor and major complication rates were 14.8% (95% CI, 7.4%-23.8%) and 2.6% (95% CI, 0%-7.8%). MWA demonstrated favorable short- to intermediate-term oncologic outcomes with low complication rates, including in the T1b subset, with moderate quality of data and heterogeneity of assessed outcomes. This supports MWA as a safe and effective treatment for RCC and a potential viable option for larger tumors.
经皮微波消融（MWA）作为一种新的经皮肾肿瘤消融能量方式已经出现，与射频和冷冻消融相比具有潜在优势。我们的研究目的是确定可疑肾肿块的 MWA 结果，其中包括经活检证实的肾细胞癌（RCC）和较大（T1b）肿瘤的亚组分析。 确定了报告 RCC 患者 MWA 结果的研究。使用具有倒数方差加权的随机效应模型对包括技术成功率（TSR）、技术有效率（TER）、局部复发率（LRR）、癌症特异性生存率（CSSR）、总生存率（OSR）和并发症在内的结果进行汇总。 在纳入的 914 项研究中，有 27 项研究（共 1584 例患者[1683 例恶性肾肿瘤]）纳入分析。汇总的 TSR 和 TER 分别为 99.6%（95%置信区间[CI]，98.0%-100%）和 96.2%（95%CI，93.8%-98.2%）。汇总的 LRR 为 3.2%（95%CI，1.9%-4.7%）。在 1、3 和 5 年时，汇总的 CSSR 分别为 100%（95%CI，99.4%-100%）、100%（95%CI，98.4%-100%）和 97.7%（95%CI，94.5%-99.7%），而汇总的 OSR 分别为 99.0%（95%CI，97.5%-99.9%）、96.0%（95%CI，93.1%-98.3%）和 88.1%（95%CI，80.3%-94.2%）。汇总的轻微和主要并发症发生率分别为 10.3%（95%CI，7.1%-13.9%）和 1.0%（95%CI，0.3%-2.1%）。在 204 例有 208 个 T1b 肿瘤的患者中，汇总的 TSR 和 TER 分别为 100%（95%CI，96.6%-100%）和 85.2%（95%CI，71.0%-95.8%）。汇总的 LRR 为 4.2%（95%CI，0.9%-8.9%）。在 1、3 和 5 年时，汇总的 CSSR 分别为 98.2%（95%CI，88.7%-100%）、97.2%（95%CI，78.5%-100%）和 98.1%（95%CI，72.3%-100%）。在 1 年和 3 年时，汇总的 OSR 分别为 94.3%（95%CI，85.7%-99.6%）和 89.3%（95%CI，68.7%-100%）。汇总的轻微和主要并发症发生率分别为 14.8%（95%CI，7.4%-23.8%）和 2.6%（95%CI，0%-7.8%）。 MWA 具有良好的短期至中期肿瘤学结果，并发症发生率低，包括 T1b 亚组，数据质量中等，评估结果存在异质性。这支持 MWA 作为 RCC 的安全有效的治疗方法，也是较大肿瘤的潜在可行选择。
