Percutaneous ablation or minimally invasive partial nephrectomy for cT1a renal masses? A propensity score-matched analysis
Percutaneous ablation or minimally invasive partial nephrectomy for cT1a renal masses? A propensity score-matched analysis
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DOI：
10.1111/iju.14758
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发表时间：
2021-12-11
影响因子：
2.6
通讯作者：
Schiavina, Riccardo
中科院分区：
文献类型：
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作者：
Bianchi, Lorenzo;Chessa, Francesco;Schiavina, Riccardo
目的局部肿瘤消融术治疗肾脏小肿块的病例日益增多。本研究的目的是比较T1期肾肿块患者接受肾部分切除术和局部肿瘤消融术治疗的肿瘤学结局。方法为了减少接受腹腔镜或机器人辅助肾部分切除术（n = 405）和局部肿瘤消融术（n = 137）的患者之间的固有差异，我们使用1：1倾向评分匹配分析。肿瘤局部消融术包括射频消融术和冷冻消融术。采用Kaplan-Meier法估计无病生存期、总生存期和无其他原因死亡生存率。多变量逻辑回归和竞争风险回归模型分别用于确定并发症、复发和其他原因死亡率的预测因子。结果肾部分切除术的5年无病生存率高于局部肿瘤消融术（92.8%vs80.4%，P = 0.02），射频消融术与冷冻消融术之间无显著性差异（P = 0.9）。消融术与肾部分切除术的总生存率估计相当（5年时91% vs 95.8%，P = 0.6）。年龄70岁的患者接受肾部分切除术和消融术的5年复发率分别为7.9%和23.8%;年龄70岁的患者接受肾部分切除术和消融术的5年其他原因死亡率分别为0%和2.2%。在多变量分析中，消融术与较少的并发症相关（比值比0.41; P = 0.01）。在竞争风险分析中，年龄（风险比0.96）和消融术（风险比4.56）是疾病复发的独立预测因素（均P
Objective Local tumor ablation to treat small renal mass is increasing. The aim of the present study was to compare oncologic outcomes among patients with T1 renal mass treated with partial nephrectomy and local tumor ablation. Methods To reduce the inherent differences between patients undergoing laparoscopic or robot-assisted partial nephrectomy (n = 405) and local tumor ablation (n = 137), we used a 1:1 propensity score-matched analysis. Local tumor ablation consisted of radiofrequency ablation and cryoablation. Disease-free survival, overall survival and other causes mortality-free survival rates were estimated using the Kaplan-Meier method. Multivariable logistic regression and competing-risk regression models were used to identify predictors of complications, recurrence and other causes mortality, respectively. Results Partial nephrectomy had higher disease-free survival estimates, as compared with local tumor ablation (92.8% vs 80.4% at 5 years, P = 0.02), with no significant difference between radiofrequency ablation and cryoablation (P = 0.9). Ablation showed comparable overall survival estimates to partial nephrectomy (91% vs 95.8% at 5 years, P = 0.6). The 5-year recurrence rates were 7.9% versus 23.8% for patients aged 70 years treated with partial nephrectomy and ablation, respectively; the 5-year other causes mortality rates were 0% and 2.2% for patients treated with partial nephrectomy and ablation aged 70 years treated with partial nephrectomy and ablation, respectively. At multivariable analysis, ablation was associated with fewer complications (odds ratio 0.41; P = 0.01). At competing risks analysis, age (hazard ratio 0.96) and ablation (hazard ratio 4.56) were independent predictors of disease recurrence (all P