Ten-Year Experience with Percutaneous Cryoablation of Renal Tumors: Tumor Size Predicts Disease Progression

被引:23
作者
Pickersgill, Nicholas A. [1 ]
Vetter, Joel M. [1 ]
Kim, Eric H. [1 ]
Cope, Sky J. [2 ]
Du, Kefu [1 ]
Venkatesh, Ramakrishna [1 ]
Giardina, Joseph Daniel [3 ]
Saad, Nael E. S. [4 ]
Bhayani, Sam B. [1 ]
Figenshau, Robert S. [1 ]
机构
[1] Washington Univ, Sch Med, Div Urol Surg, Dept Surg, Campus Box 8242 4960 Childrens Pl, St Louis, MO 63110 USA
[2] Univ Missouri, Sch Med, Kansas City, MO 64108 USA
[3] Washington Univ, Sch Med, Div Intervent Radiol, Mallinckrodt Inst Radiol, St Louis, MO 63110 USA
[4] Univ Rochester, Med Ctr, Dept Radiol, Div Intervent Radiol, Rochester, NY 14642 USA
关键词
kidney; carcinoma; renal cell; cryosurgery; disease progression; forecasting; RADIOFREQUENCY ABLATION; CELL CARCINOMA; MASSES; COMPLICATIONS; NEPHRECTOMY; RECURRENCE; EFFICACY; CANCER; CM;
D O I
10.1089/end.2019.0882
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Introduction:Percutaneous cryoablation (PCA) has emerged as an alternative to extirpative management of small renal masses (SRMs) in select patients, with a reduced risk of perioperative complications. Although disease recurrence is thought to occur in the early postoperative period, limited data on long-term oncologic outcomes have been published. We reviewed our 10-year experience with PCA for SRMs and assessed predictors of disease progression. Materials and Methods:We reviewed our prospectively maintained database of patients who underwent renal PCA from March 2005 to December 2015 (n = 308). Baseline patient and tumor variables were recorded, and postoperative cross-sectional imaging was examined for evidence of disease recurrence. Disease progression was defined as the presence of local recurrence or new lymphadenopathy/metastasis. Results:Mean patient age was 67.2 +/- 11 years, mean tumor size was 2.7 +/- 1.3 cm, and mean nephrometry score was 6.8 +/- 1.7. At mean follow-up of 38 months, local recurrence and new lymphadenopathy/metastasis occurred in 10.1% (31/308) and 6.2% (19/308) of patients, respectively. Excluding patients with a solitary kidney and/or von Hippel-Lindau, local recurrence and new lymphadenopathy/metastasis occurred in 8.6% (23/268) and 1.9% (5/268) of cases, respectively. Kaplan-Meier estimated disease-free survival was 92.5% at 1 year, 89.3% at 2 years, and 86.7% at 3 years post-PCA. Increasing tumor size was a significant predictor of disease progression (hazard ratio 1.32 per 1-cm increase in size,p = 0.001). Conclusions:PCA is a viable treatment option for patients with SRMs. Increasing tumor size is a significant predictor of disease progression following PCA.
引用
收藏
页码:1211 / 1217
页数:7
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