Prospective Analysis of the Safety and Efficacy of Percutaneous Cryoablation for pT1NxMx Biopsy-Proven Renal Cell Carcinoma
Prospective Analysis of the Safety and Efficacy of Percutaneous Cryoablation for pT1NxMx Biopsy-Proven Renal Cell Carcinoma
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经皮冷冻消融治疗经活检证实的 pT1NxMx 肾细胞癌的安全性和有效性的前瞻性分析
DOI：
10.1007/s00270-010-9934-7
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发表时间：
2011
影响因子：
2.9
通讯作者：
C. Georgiades
中科院分区：
文献类型：
--
作者：
R. Rodriguez;Z. Cizman;K. Hong;Alexandra Koliatsos;C. Georgiades
目的我们的目的是确定图像引导经皮冷冻消融治疗美国癌症联合委员会 pT1ANxMx 和 pT1BNxMx 活检证实的肾细胞癌 (RCC) 的有效性和安全性。材料和方法计算机断层扫描 (CT) 引导经皮冷冻消融治疗连续 113 例肾细胞癌患者的 117 个肾脏病变。 pT1NxMx RCC。所有 117 项消融均纳入安全性分析，并根据不良事件通用术语标准 3.0 版 (CTCAE v3.0) 对并发症进行分类。 81 个病灶经活检证实为 RCC，并纳入疗效分析。技术成功被定义为覆盖整个病变的“冰球”加上最小 5 毫米的边缘。疗效被定义为在随后的后续影像学研究中完全没有增强且尺寸持续减小。结果技术成功率为 100%，其中 15% 的消融需要注射空气或盐水以防止非目标消融。我们记录的临床显着并发症（CTCAE 类别≥2）发生率为 7%，死亡率为 0%。肾功能没有受到不利影响。百分之七十的患者当天出院回家。中位随访 67 周（范围 7-172）的疗效为 98.7%。对于中位随访时间为 2 年 (n= 59) 和 3 年 (n= 13) 的患者亚组，有效率分别为 98.3% 和 92.3%。癌症特异性生存率为 100%。 结论 CT 引导下的经皮冷冻消融术对于 T1A 和 T1B 期 RCC 具有出色的安全性和有效性。然而，需要更长时间的随访才能将其与其他保留肾单位的手术治疗进行比较。对于非手术患者、不能进一步牺牲肾功能的患者以及有异时性病变风险的患者来说，这是一个很好的选择。
PurposeOur objective was to determine the efficacy and safety of image-guided, percutaneous cryoablation for American Joint Committee on Cancer pT1ANxMx and pT1BNxMx biopsy-proven renal cell carcinoma (RCC).Materials and MethodsComputed tomography (CT)-guided, percutaneous cryoablation was used to treat 117 renal lesions in 113 consecutive patients with pT1NxMx RCC. All 117 ablations were included in the safety analysis, and complications were categorized according to Common Terminology Criteria for Adverse Events version 3.0 (CTCAE v3.0). Eighty-one lesions were biopsy-proven RCC and were included in the efficacy analysis. Technical success was defined as the “ice-ball” covering the entire lesion plus a minimum 5-mm margin. Efficacy was defined as complete lack of enhancement and continuous decrease in size on subsequent follow-up imaging studies.ResultsTechnical success was 100%, with 15% of ablations requiring air or saline injection to prevent nontarget ablation. We recorded a 7% rate of clinically significant complications (CTCAE category ≥2) and 0% mortality. Renal function was not adversely affected. Seventy percent of patients were discharged to home on the same day. Efficacy was 98.7% for a median follow-up of 67 weeks (range 7–172). For the subgroup of patients that reached a median follow-up of 2 (n= 59) and 3 years (n= 13), efficacy was 98.3 and 92.3%, respectively. Cancer specific survival was 100%.ConclusionsCT-guided, percutaneous cryoablation has an excellent safety and efficacy profile for stage T1A and T1B RCC; however, longer follow-up is needed to compare it with other nephron-sparing surgical treatments. It is a great option for nonsurgical patients, those in whom renal function cannot be further sacrificed, and those at risk for metachronous lesions.