Percutaneous Cryoablation of Metastatic Renal Cell Carcinoma for Local Tumor Control: Feasibility, Outcomes, and Estimated Cost-effectiveness for Palliation
Percutaneous Cryoablation of Metastatic Renal Cell Carcinoma for Local Tumor Control: Feasibility, Outcomes, and Estimated Cost-effectiveness for Palliation
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DOI：
10.1016/j.jvir.2012.03.002
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发表时间：
2012-06-01
影响因子：
2.9
通讯作者：
Goodman, Allen C.
中科院分区：
文献类型：
--
作者：
Bang, Hyun J.;Littrup, Peter J.;Goodman, Allen C.
目的：评价多部位冷冻消融(MCA)治疗少转移性肾细胞癌(RCC)的并发症、局部复发率、总生存率(OS)和成本-效果评估。材料和方法：共对27例患者(3名女性和24名男性)的72个肿瘤进行了60次CT和/或超声引导的经皮MCA手术。患者平均年龄63岁。肿瘤部位按常见转移部位分组。已建立的手术选择标准对患者状态进行分级。采用Kaplan-Meier法测定中位OS，并计算其定义寿命(LYGs)。结果：每个解剖部位的肿瘤总数和冷冻消融手术数分别为：肾切除床11例和11例；肾上腺9例和8例；腹主动脉旁7例和6例；肺14例和13例；骨13例和13例；浅层12例和9例；腹膜内5例和3例；肝脏1例和1例。平均每个患者进行了2.2次手术，平均临床随访时间为16个月。主要并发症和局部复发率分别为2%(1/60)和3%(2/72)。没有患者被评为具有良好的手术风险，但中位OS为2.69年，估计5年生存率为27%。根据历史成本比较，冷冻消融在有或没有系统性治疗的情况下仍然具有成本效益，附加成本-效果比为28,312-559,554美元/LYG。结论：在所有解剖部位，MCA的发病率和局部肿瘤复发率都非常低，OS明显增加。即使作为全身治疗的辅助手段，MCA对于姑息治疗少转移性肾癌似乎也是经济有效的。
Purpose: To assess complications, local tumor recurrences, overall survival (OS), and estimates of cost-effectiveness for multisite cryoablation (MCA) of oligometastatic renal cell carcinoma (RCC).Materials and Methods: A total of 60 computed tomography- and/or ultrasound-guided percutaneous MCA procedures were performed on 72 tumors in 27 patients (three women and 24 men). Average patient age was 63 years. Tumor location was grouped according to common metastatic sites. Established surgical selection criteria graded patient status. Median OS was determined by Kaplan-Meier method and defined life-years gained (LYGs). Estimates of MCA costs per LYG were compared with established values for systemic therapies.Results: Total number of tumors and cryoablation procedures for each anatomic site are as follows: nephrectomy bed, 11 and 11; adrenal gland, nine and eight; paraaortic, seven and six; lung, 14 and 13; bone, 13 and 13; superficial, 12 and nine; intraperitoneal, five and three; and liver, one and one. A mean of 2.2 procedures per patient were performed, with a median clinical follow-up of 16 months. Major complication and local recurrence rates were 2% (one of 60) and 3% (two of 72), respectively. No patients were graded as having good surgical risk, but median OS was 2.69 years, with an estimated 5-year survival rate of 27%. Cryoablation remained cost-effective with or without the presence of systemic therapies according to historical cost comparisons, with an adjunctive cost-effectiveness ratio of $28,312-559,554 per LYG.Conclusions: MCA was associated with very low morbidity and local tumor recurrence rates for all anatomic sites, with apparent increased OS. Even as an adjunct to systemic therapies, MCA appeared cost-effective for palliation of oligometastatic RCC.