微波与射频消融治疗小肾肿瘤：围手术期及肿瘤学结局

Microwave vs radiofrequency ablation for small renal masses: perioperative and oncological outcomes.

作者信息

Jannello Letizia Maria Ippolita, Orsi Franco, Luzzago Stefano, Mauri Giovanni, Mistretta Francesco A, Piccinelli Mattia Luca, Vaccaro Chiara, Tozzi Marco, Maiettini Daniele, Varano Gianluca, Caramella Stefano, Della Vigna Paolo, Ferro Matteo, Bonomo Guido, Tian Zhe, Karakiewicz Pierre I, De Cobelli Ottavio, Musi Gennaro

机构信息

Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy.

Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada.

出版信息

BJU Int. 2025 Jan;135(1):156-165. doi: 10.1111/bju.16528. Epub 2024 Sep 18.

DOI:10.1111/bju.16528

PMID:39290073

Abstract

OBJECTIVE

To conduct a comprehensive comparison of microwave ablation (MWA) vs radiofrequency ablation (RFA) outcomes in the treatment of small renal masses (SRMs), specifically: TRIFECTA ([i] complete ablation, [ii] absence of Clavien-Dindo Grade ≥III complications, and [iii] absence of ≥30% decrease in estimated glomerular filtration rate) achievement, operative time (OT), and local recurrence rate (LRR).

PATIENTS AND METHODS

We retrospectively analysed 531 patients with SRMs (clinical T1a-b) treated with MWA or RFA at a single centre (2008-2022). First, multivariable logistic regression models were used for testing TRIFECTA achievement. Second, multivariable Poisson regression models were used to evaluate variables associated with longer OT. Finally, Kaplan-Meier plots depicted LRR over time. All analyses were repeated after 1:1 propensity score matching (PSM).

RESULTS

Of 531 patients with SRMs, 373/531 (70.2%) underwent MWA and 158/531 (29.8%) RFA. MWA demonstrated superior TRIFECTA achievement (314/373 [84.2%]) compared to RFA (114/158 [72.2%], P = 0.001). These differences were driven by higher rates of complete ablation in MWA- vs RFA-treated patients (348/373 [93.3%] vs 137/158 [86.7%], P < 0.001). In multivariable logistic regression models, MWA was associated with higher TRIFECTA achievement, compared to RFA, before (odds ratio [OR] 1.92, P = 0.008) and after PSM (OR 1.99, P = 0.023). Finally, the median OT was shorter for MWA vs RFA (105 vs 115 min; P = 0.002). At Poisson regression analyses, MWA predicted shorter OT before (incidence rate ratio [IRR] 0.86, P < 0.001) and after PSM (IRR 0.85, P < 0.001). Local recurrence occurred in 17/373 (4.6%) MWA-treated patients and 21/158 (13.3%) RFA-treated patients (P = 0.29) after a median (interquartile range) follow-up of 24 (8-46) months. There were no differences in the LRR in Kaplan-Meier plots before (P = 0.29) and after PSM (P = 0.42).

CONCLUSION

Microwave ablation provides higher TRIFECTA achievement, and shorter OT than RFA. No significant differences were found regarding the LRR.

摘要

目的

对微波消融（MWA）与射频消融（RFA）治疗小肾肿块（SRM）的疗效进行全面比较，具体包括：三联成功指标（[i]完全消融，[ii]无Clavien-Dindo≥III级并发症，以及[iii]估计肾小球滤过率下降幅度<30%）的达成情况、手术时间（OT）和局部复发率（LRR）。

患者与方法

我们回顾性分析了在单一中心（2008 - 2022年）接受MWA或RFA治疗的531例SRM患者（临床T1a - b期）。首先，使用多变量逻辑回归模型检验三联成功指标的达成情况。其次，使用多变量泊松回归模型评估与较长手术时间相关的变量。最后，绘制Kaplan-Meier曲线以描述随时间变化的局部复发率。在1:1倾向评分匹配（PSM）后重复所有分析。

结果

在531例SRM患者中，373/531（70.2%）接受了MWA治疗，158/531（29.8%）接受了RFA治疗。与RFA（114/158 [72.2%]）相比，MWA的三联成功指标达成率更高（314/373 [84.2%]，P = 0.001）。这些差异是由于MWA治疗患者的完全消融率高于RFA治疗患者（348/373 [93.3%] 对137/158 [86.7%]，P < 0.001）。在多变量逻辑回归模型中，与RFA相比，MWA在PSM前（优势比[OR] 1.92，P = 0.008）和PSM后（OR 1.99，P = 0.023）与更高的三联成功指标达成率相关。最后，MWA的中位手术时间比RFA短（105对115分钟；P = 0.002）。在泊松回归分析中，MWA在PSM前（发病率比[IRR] 0.86，P < 0.001）和PSM后（IRR 0.85，P < 0.001）预测手术时间更短。在中位（四分位间距）随访24（8 - 46）个月后，17/373（4.6%）接受MWA治疗的患者和21/158（13.3%）接受RFA治疗的患者出现局部复发（P = 0.29）。在Kaplan-Meier曲线中，PSM前（P = 0.29）和PSM后（P = 0.42）的局部复发率无差异。