Percutaneous Ablation Versus Partial and Radical Nephrectomy for T1a Renal Cancer: A Population-Based Analysis.
Percutaneous Ablation Versus Partial and Radical Nephrectomy for T1a Renal Cancer: A Population-Based Analysis.
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DOI：
10.7326/m17-0585
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发表时间：
2018-07-17
影响因子：
39.2
通讯作者：
Kwan SW
中科院分区：
文献类型：
--
作者：
Talenfeld AD;Gennarelli RL;Elkin EB;Atoria CL;Durack JC;Huang WC;Kwan SW
T1 a期肾细胞癌（RCC，< 4 cm）通常是偶然发现和可治愈的。保留肾单位的肾部分切除术（PN）已取代根治性肾切除术（RN）作为标准治疗。RN仍然是二线治疗选择，而经皮消融（PA），一种较新的非手术治疗，由于数据相对缺乏，仍然是三线治疗选择。比较PA、PN和RN结局。前瞻性收集的人群水平登记数据的基于倾向评分的治疗加权逆概率比较。SEER-医疗保险链接文件2006-2013。2006年至2011年，66岁及以上的患者接受了T1 a肾癌治疗。PA与PN和RN。RCC特异性和总生存率，干预后30天和365天累积并发症。4310例患者的中位总生存期随访时间为52个月，RCC特异性生存期为42个月。5-PA与PN和RN治疗后的1年RCC特异性生存率分别为95（95% CI 93-98）vs. 98%（96-99）和96（94-98）vs. 95%（93-96）。5-PA术后1年总生存率与PN相比为77（74-71）vs. 86%（84-88），与RN相比为74（71-78）vs. 75%（73-77）。PA、PN和RN后31-365天肾功能不全的累积发生率分别为11%（8-14）、9%（8-10）和18%（17-20）。PA、PN和RN后30天内的非泌尿系统并发症发生率分别为6%（4-9）、29%（27-30）和30%（28-32）。10%的PN患者在术中转为RN。7%的PA患者在治疗1年内接受了额外的PA。这些观察性数据可能受到PN组中更年轻、更健康患者的选择偏倚的残留混杂影响。老年研究人群的结果可能不太适用于年轻患者。使用SEER-Medicare链接文件阻止了对2011年后接受治疗的患者进行分析，这可能会降低最新PA、PN和RN技术的普遍性。对于精心选择的老年T1 a期肾癌患者，与RN相比，PA可能提供相似的肿瘤学结局，更少的长期肾功能不全和明显更少的围手术期并发症。PA还可以提供接近PN的肿瘤学结局，围手术期并发症较少。没有。主要研究资金和薪资支持由大学放射科医师协会的GE放射学研究学术奖学金（GERRAF）提供。统计分析的补充资金由介入放射学会（SIR）基金会提供。没有资金来源或任何器械制造商对方法学、作者决定或提交手稿以供发表的决定有任何意见。
Stage T1a renal cell carcinoma (RCC, < 4 cm) is usually incidentally detected and curable. Nephron-sparing, partial nephrectomy (PN) has replaced radical nephrectomy (RN) as standard of care. RN remains the 2nd line treatment option, while percutaneous ablation (PA), a newer, nonsurgical treatment, remains a 3rd line option due to a relative paucity of data. To compare PA, PN and RN outcomes. Propensity score-based inverse probability of treatment weighted comparison of prospectively gathered population-level registry data. SEER-Medicare linked files 2006–2013. Ages 66 and older treated for T1a renal cancers from 2006–2011. PA vs. PN and RN. RCC-specific and overall survival, 30- and 365-day post-intervention cumulative complications. 4310 patients had median follow-up of 52 months for overall survival and 42 months for RCC-specific survival. 5-year RCC-specific survival after PA vs. PN and vs. RN was 95 (95% CI 93–98) vs. 98% (96–99) and 96 (94–98) vs. 95% (93–96). 5-year post-PA overall survival vs. PN was 77 (74–71) vs. 86% (84–88) and vs. RN was 74 (71–78) vs. 75% (73–77). Cumulative rates of renal insufficiency 31–365 days after PA, PN, and RN were 11% (8–14), 9% (8–10) and 18% (17–20). Rates of non-urologic complications within 30 days after PA, PN and RN were 6% (4–9), 29% (27–30) and 30% (28–32). Ten percent of PN patients were converted intraoperatively to RN. Seven percent of PA patients received additional PA within 1 year of treatment. These observational data may be affected by residual confounding from selection bias toward younger, healthier patients in the PN group. Findings from this older study population are likely less applicable to younger patients. Use of SEER-Medicare linked files prevented analysis of patients treated after 2011, which may reduce generalizability to the newest PA, PN and RN techniques. For well-selected older stage T1a renal cancer patients, PA may offer similar oncologic outcomes, less long-term renal insufficiency and markedly fewer perioperative complications compared to RN. PA may also offer oncologic outcomes approaching those of PN, with fewer perioperative complications. None. Primary research funding and salary support were provided by a grant from the Association of University Radiologists’ GE Radiology Research Academic Fellowship (GERRAF). Supplemental funding for statistical analysis was provided by a grant from the Society of Interventional Radiology (SIR) Foundation. No funding source nor any device manufacturer had any input into methodology, authorship decisions or the decision to submit the manuscript for publication.