Faculty of Health Sciences, Medicine, University of Southern Denmark (SDU), Odense, Denmark.
Research and Innovation Unit of Radiology - UNIFY, SDU, Odense, Denmark.
Cardiovasc Intervent Radiol. 2024 Apr;47(4):453-461. doi: 10.1007/s00270-023-03633-5. Epub 2024 Mar 14.
Endophytic renal cancer treatment is a challenge. Due to difficulties in endophytic tumor visualization during surgical extirpation, image-guided percutaneous cryoablation (PCA) is an attractive alternative. The minimally invasive nature of PCA makes it favorable for comorbid patients as well as patients in which surgery is contraindicated. Oncological outcomes and complications after PCA of endophytic biopsy-proven renal cell carcinoma (RCC) were reviewed in this study.
Patients were included after a multidisciplinary team conference from January 2015 to November 2021. Inclusion criteria were endophytic biopsy-proven T1 RCC treated with PCA with one year of follow-up. Complications were reported according to the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) classification system and the Clavien-Dindo classification (CDC) system. Major complications were defined as a grade ≥ 3 according to the CDC.
Fifty-six patients were included with a total of 56 endophytic tumors treated during 61 PCA sessions. The median RENAL nephrometry score was 9 (IQR 2), and the mean tumor size was 25.7 mm (SD ± 8.9 mm). Mean hospitalization time was 0.39 (SD ± 1.1) days. At a mean follow-up of 996 days (SD ± 559), 86% of tumors were recurrence free after one PCA. No patients progressed to metastatic disease. According to the CIRSE classification, 10.7% (n = 6) had grade 3 complications, and 5.4% (n = 3) had CDC major complications.
This study demonstrates that PCA of endophytic biopsy-proven T1 RCC is safe with few major complications and excellent local tumor control rates at almost three-year mean follow-up. LEVEL OF EVIDENCE 3: Retrospective cohort study.
内生性肾癌的治疗具有挑战性。由于在外科切除过程中难以观察内生性肿瘤，因此图像引导经皮冷冻消融（PCA）是一种有吸引力的替代方法。PCA 的微创性质使其成为合并症患者以及手术禁忌患者的理想选择。本研究回顾了经皮活检证实的内生性肾细胞癌（RCC）行 PCA 后的肿瘤学结果和并发症。
本研究纳入了 2015 年 1 月至 2021 年 11 月期间经多学科团队会议选择的患者。纳入标准为接受 PCA 治疗的内生性活检证实的 T1 RCC，随访时间为 1 年。并发症根据心血管和介入放射学学会（CIRSE）分类系统和 Clavien-Dindo 分类（CDC）系统进行报告。主要并发症定义为根据 CDC 分级≥3 级的并发症。
共纳入 56 例患者，共 56 个内生性肿瘤，接受了 61 次 PCA 治疗。中位 RENAL 肾单位评分 9（IQR 2），平均肿瘤大小 25.7±8.9mm。平均住院时间为 0.39（SD±1.1）天。在平均 996 天（SD±559）的随访中，一次 PCA 后 86%的肿瘤无复发。无患者进展为转移性疾病。根据 CIRSE 分类，有 10.7%（n=6）发生 3 级并发症，5.4%（n=3）发生 CDC 主要并发症。
本研究表明，对于经皮活检证实的 T1 RCC 内生性肿瘤，PCA 治疗安全，并发症少，在近 3 年的平均随访中局部肿瘤控制率高。证据水平 3：回顾性队列研究。
