Int J Urol:在治疗cT1a型肾肿瘤中,经皮消融与微创肾部分切除术哪个好?

2022-01-11 AlexYang MedSci原创

比较了T1肾脏肿块患者中,接受肾脏部分切除术和局部肿瘤消融术的肿瘤学结果情况。

目前,检测到的RCC尺寸越来越小,导致越来越多的人采用微创PN作为T1 RCC的首选治疗方法。然而,局部肿瘤消融(包括RFA和Cryo)以及主动监测,在老年人和合并症患者中得到了普及,主要是由于比手术负担小。

在治疗小肾脏肿块中,局部肿瘤消融术的使用正在增加。近期,来自意大利的研究人员在《Int J Urol》杂志上发表文章,比较了T1肾脏肿块患者中,接受肾脏部分切除术和局部肿瘤消融术的肿瘤学结果情况

为了减少接受腹腔镜或机器人辅助的肾脏部分切除术(n=405)和局部肿瘤消融术(n=137)患者之间的内在差异,研究人员采用了1:1的倾向性评分匹配分析。局部肿瘤消融术包括射频消融和冷冻消融。使用Kaplan-Meier方法估计了无疾病生存率、总生存率和其他原因的无死亡生存率。多变量逻辑回归和竞争风险回归模型分别用来确定并发症、复发和其他原因死亡的预测因素

结果发现,与局部肿瘤消融术相比,部分肾切除术的无疾病生存率更高(5年时为92.8% vs 80.4%,P=0.02),射频消融术和冷冻消融术之间没有明显差异(P=0.9)。消融术显示出了与肾脏部分切除术相当的总生存(5年时为91% vs 95.8%,P=0.6)。在接受肾脏部分切除术和消融术治疗的患者中,5年复发率在年龄≤70岁患者中分别为7.9%和23.8%;而年龄>70岁患者的5年复发率为分别为2.5%和11.9%。而接受肾脏部分切除术和消融术治疗患者的5年其他原因死亡率在年龄≤70岁的患者中分别为0%和2.2%,而在年龄>70岁患者中分别为3%和10.9%。在多变量分析中,消融术与较少的并发症有关(几率比0.41;P=0.01)。在竞争风险分析中,年龄(危险比0.96)和消融术(危险比4.56)是疾病复发的独立预测因素(所有P≤0.008)

多变量回归分析

 

综上所述,与肾脏部分切除术相比,局部肿瘤消融术显示出较高的复发风险和较低的并发症风险,总生存率相当

 

原始出处:

Lorenzo Bianchi , Francesco Chessa , Pietro Piazza et al. Percutaneous ablation or minimally invasive partial nephrectomy for cT1a renal masses? A propensity score-matched analysis. Int J Urol. Dec 2021.

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    2022-01-24 ms3000000351422885

    学习

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    2022-01-23 盖伦

    学习了

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    2022-01-13 robbert123

    学习

    0

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    2022-01-12 vera_1203
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