Minimally Invasive Tumor Therapies Center, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China.
Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
Korean J Radiol. 2024 Dec;25(12):1061-1069. doi: 10.3348/kjr.2024.0462. Epub 2024 Nov 3.
There is controversy among different guidelines regarding the use of thermal ablation to treat clinical T1a renal cell carcinomas with tumor sizes ranging from 3.1-4 cm. Therefore, we compared oncological outcomes between heat-based thermal ablation (hTA) and cryoablation (CA) in patients with solid T1a renal cell carcinomas, including those with a tumor size ≤3 cm and a tumor size of 3.1-4 cm.
Within the Surveillance, Epidemiology, and End Results database (2000-2019), we identified patients with clinical T1a renal cell carcinomas that were histologically confirmed and treated with hTA or CA. After propensity score matching using a 1:1 ratio, the overall survival (OS) and cancer-specific survival (CSS) were estimated and compared between the two methods. Cancer-specific mortality (CSM) was also analyzed, considering other-cause mortality as a competing risk.
Of the 3513 assessable patients, 1426 (40.6%) and 2087 (59.4%) were treated with hTA and CA, respectively. After propensity score matching, the hTA and CA groups included 1393 and 1393 patients, respectively. hTA was associated with shorter OS than CA with a hazard ratio of 1.17 (95% confidence interval, 1.04-1.32; = 0.010). The hTA and CA groups did not reveal statistically significant differences in CSS with a hazard ratio of 1.07 (95% confidence interval, 0.76-1.50; = 0.706). The hTA and CA groups did not show statistically significant differences in CSM ( = 0.849). However, the hTA group showed a significantly higher other-cause mortality ( = 0.011).
In patients with clinical stage T1a renal cell carcinomas, hTA was comparable to CA in terms of CSS and CSM. However, hTA resulted in a slightly shorter OS than CA. Large-scale randomized clinical trials are required to obtain more robust evidence.
不同指南在治疗肿瘤直径为 3.1-4cm 的临床 T1a 肾细胞癌时使用热消融的方法存在争议。因此，我们比较了热消融（hTA）和冷冻消融（CA）治疗实体 T1a 肾细胞癌患者的肿瘤直径≤3cm 和 3.1-4cm 的肿瘤的肿瘤学结果。
我们在 Surveillance，Epidemiology，and End Results（2000-2019）数据库中，确定了经组织学证实并接受 hTA 或 CA 治疗的临床 T1a 肾细胞癌患者。采用 1：1 比例的倾向评分匹配后，比较两种方法的总生存期（OS）和癌症特异性生存期（CSS）。还考虑了其他原因的死亡率作为竞争风险，分析了癌症特异性死亡率（CSM）。
在 3513 例可评估患者中，分别有 1426（40.6%）例和 2087（59.4%）例接受了 hTA 和 CA 治疗。在倾向评分匹配后，hTA 和 CA 组分别纳入了 1393 例和 1393 例患者。hTA 与 CA 相比，OS 较短，风险比为 1.17（95%置信区间，1.04-1.32； = 0.010）。hTA 和 CA 组在 CSS 方面没有统计学上的显著差异，风险比为 1.07（95%置信区间，0.76-1.50； = 0.706）。hTA 和 CA 组在 CSM 方面没有统计学上的显著差异（ = 0.849）。然而，hTA 组的其他原因死亡率明显更高（ = 0.011）。
在临床 T1a 肾细胞癌患者中，hTA 在 CSS 和 CSM 方面与 CA 相当，但 hTA 导致 OS 略短于 CA。需要进行大规模的随机临床试验以获得更有力的证据。
