Justo-Jaume Carlos, Stempel Max, Qiu Jessica, Gonzalez Miranda Luis, Yan Guofen, Lyons Genevieve, Sands Kenneth, Schenkman Noah, Krupski Tracey, Culp Stephen, Lobo Jennifer
University of Virginia, Charlottesville, USA.
Abdom Radiol (NY). 2025 Jan 7. doi: 10.1007/s00261-024-04779-7.
To assess the safety and efficacy of using microwave ablation (MWA) to treat solitary kidney (SK) patients with T1a renal cell carcinoma (RCC).
Retrospective analysis of a prospectively maintained database identified patients with T1a RCC with either congenital or acquired SK. Estimated glomerular filtration rate (eGFR) was calculated from serum creatinine before MWA and after at 6 and 12 months post-procedure. The local recurrence-free survival (LRFS), metastatic-recurrence free survival (MRFS), cancer-specific survival, and overall survival were analyzed with the Kaplan-Meier method.
A total of 26 patients met inclusion criteria, including 3 congenital and 23 acquired SK patients. eGFR was lower at both 6 and 12 months post-procedure compared to pre-procedure, with the congenital SK group having a more pronounced reduction in eGFR at both post-procedure timepoints. Median follow-up time was 28.6 months (IQR 12.4-55.4). Four patients (15.4%) experienced local recurrence. For LRFS, mean survival time was 69.4 months. There were 5 patients (19.2%) that experienced metastatic recurrence, with median and mean survival time at 101.1 and 82.0 months, respectively. The mean time for RCC-specific survival was 94.7 months, while median and mean time for overall survival was 43.1 and 61.7 months, respectively.
With a moderate reduction in renal function and a comparable rate of local recurrence compared to prior literature, this work demonstrates that MWA remains a viable alternative to more invasive techniques, particularly for high-risk SK patients with RCC. Our work highlights the need for further research on effectiveness of MWA in cancer control and preservation of renal function in larger cohorts of SK patients over extended follow-up times.
评估使用微波消融（MWA）治疗孤立肾（SK）合并T1a期肾细胞癌（RCC）患者的安全性和有效性。
对一个前瞻性维护的数据库进行回顾性分析，确定患有先天性或后天性SK的T1a期RCC患者。根据MWA术前及术后6个月和12个月时的血清肌酐计算估算肾小球滤过率（eGFR）。采用Kaplan-Meier法分析局部无复发生存率（LRFS）、远处无复发生存率（MRFS）、癌症特异性生存率和总生存率。
共有26例患者符合纳入标准，包括3例先天性SK患者和23例后天性SK患者。与术前相比，术后6个月和12个月时eGFR均降低，先天性SK组在两个术后时间点eGFR降低更为明显。中位随访时间为28.6个月（四分位间距12.4 - 55.4）。4例患者（15.4%）出现局部复发。对于LRFS，平均生存时间为69.4个月。有5例患者（19.2%）出现远处复发，中位生存时间和平均生存时间分别为101.1个月和82.0个月。RCC特异性生存的平均时间为94.7个月；而总生存的中位时间和平均时间分别为43.1个月和61.7个月。
与先前文献相比，肾功能有适度下降且局部复发率相当，本研究表明MWA仍然是侵入性更强技术的可行替代方案，特别是对于高危的SK合并RCC患者。我们的研究强调需要在更大规模的SK患者队列中进行更长时间的随访，进一步研究MWA在癌症控制和肾功能保留方面的有效性。
