Ozawa Mizuki, Sone Miyuki, Sugawara Shunsuke, Itou Chihiro, Kimura Shintaro, Kusumoto Masahiko, Matsui Yoshiyuki
Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan.
Cancer Medicine, Jikei University Graduate School of Medicine, Tokyo, Japan.
Acta Radiol. 2025 May;66(5):487-493. doi: 10.1177/02841851241310408. Epub 2025 Feb 21.
BackgroundRenal cell carcinomas (RCCs) adjacent to critical structures can be safely treated using percutaneous cryoablation with adjunctive techniques. However, there are only a few reports describing the factors affecting local tumor control after percutaneous cryoablation for such RCCs.PurposeTo evaluate the factors affecting local tumor control in the percutaneous cryoablation of RCCs adjacent to critical structures.Material and MethodsA total of 403 tumors from 328 patients were retrospectively reviewed. Patients with histologically proven RCCs adjacent to critical structures with at least 1 year of follow-up after treatment were included. Hereditary RCCs were excluded. Of the 403 tumors, 40 met the criteria. Owing to the tumor location, all procedures were performed using adjunctive techniques. Baseline, perioperative, and follow-up data were collected and factors affecting local tumor progression were evaluated. Comparisons between groups with and without local tumor progression were performed using Fisher's exact test or Wilcoxon's rank sum test.ResultsThe median follow-up was 1289.5 days. Local tumor progression was observed in 7/40 (17.5%) patients. Univariate analysis revealed that significant factors affecting local tumor progression were situated adjacent to the ureter ( = 0.005), requiring adjunctive techniques other than hydro- and/or pneumo-dissection ( = 0.005), as well as the distance between tumors and critical structures ( = 0.04). The ice-ball margin tended to be smaller in the group with local tumor progression but this was not significant ( = 0.07).ConclusionRenal tumors adjacent to the ureter may result in local tumor progression after cryoablation compared with tumors adjacent to other organs.
背景
毗邻关键结构的肾细胞癌（RCC）可通过经皮冷冻消融联合辅助技术进行安全治疗。然而，仅有少数报告描述了此类RCC经皮冷冻消融后影响局部肿瘤控制的因素。
目的
评估毗邻关键结构的RCC经皮冷冻消融中影响局部肿瘤控制的因素。
材料与方法
回顾性分析了328例患者的403个肿瘤。纳入经组织学证实毗邻关键结构且治疗后至少随访1年的RCC患者，排除遗传性RCC。403个肿瘤中，40个符合标准。由于肿瘤位置原因，所有操作均采用辅助技术。收集基线、围手术期及随访数据，并评估影响局部肿瘤进展的因素。采用Fisher精确检验或Wilcoxon秩和检验对有或无局部肿瘤进展的组间进行比较。
结果
中位随访时间为1289.5天。40例患者中有7例（17.5%）出现局部肿瘤进展。单因素分析显示，影响局部肿瘤进展的显著因素包括位于输尿管附近（P = 0.005）、需要水囊和/或气腔分离以外的辅助技术（P = 0.005）以及肿瘤与关键结构之间的距离（P = 0.04）。局部肿瘤进展组的冰球边缘往往较小，但差异无统计学意义（P = 0.07）。
结论
与毗邻其他器官的肿瘤相比，毗邻输尿管的肾肿瘤冷冻消融后可能导致局部肿瘤进展。
