Background

While partial nephrectomy (PN) is considered the standard approach for a tumor in a solitary kidney, percutaneous cryoablation (PCA) is emerging as an alternative nephron-sparing option.

Objective

To compare outcomes between PCA and PN for tumors in a solitary kidney.

Design, setting, and participants

Patients who underwent PCA or PN between 2005 and 2015 for a single primary renal tumor in a solitary kidney were identified using Mayo Clinic Registries. Exclusion criteria were inherited tumor syndromes and salvage procedures.

Intervention

PCA and PN.

Outcome measurements and statistical analysis

To achieve balance in baseline characteristics, we used inverse probability of treatment weighting (IPTW) based on propensity to receive treatment. The risk of having a post-treatment complication and percent drop in estimated glomerular filtration rate (eGFR), as well as the risks of local/ipsilateral recurrence, distant metastasis, and cancer-specific mortality, were compared between groups using logistic, linear, and Fine-and-Gray competing risk regression models.

Results and limitations

The cohort included 118 patients (PCA: 54; PN: 64) with a median follow-up of 47 mo (interquartile range 18, 74). In unadjusted analyses, PCA was associated with a lower risk of complications (15% vs 31%; odds ratio [OR] = 0.38; 95% confidence interval [CI] 0.15, 0.96; p = 0.04). However, upon accounting for baseline differences with IPTW adjustment, there was no longer a significant difference in the risk of complications (28% vs 29%; OR = 0.95; 95% CI 0.53, 1.69; p = 0.9). There were no significant differences between PCA and PN in percentage drop in eGFR at discharge (mean: 11% vs 16%; β = –5%; 95% CI –13, 3; p = 0.2) or at 3 mo (12% vs 9%; β = 3%; 95% CI –3, 10; p = 0.3). Likewise, no significant differences were noted in local recurrence (HR = 0.87; 95% CI 0.38, 1.98; p = 0.7), distant metastases (HR = 0.60; 95% CI 0.30, 1.20; p = 0.2), or cancer-specific mortality (HR = 1.13; 95% CI 0.32, 3.98; p = 0.8). Limitations include the sample size, given the relative rarity of renal masses in solitary kidneys.

Conclusions

Our study found no significant difference in complications, renal function outcomes, and oncologic outcomes between PN and PCA for patients with a tumor in a solitary kidney. Validation in a larger multi-institutional analysis may be warranted.

Patient summary

Partial nephrectomy (surgery) and percutaneous cryoablation are both options for treating a kidney tumor while preserving the normal portion of the kidney. In patients with a tumor in their only kidney, we found no difference in the risk of complications, kidney function outcomes, or cancer control outcomes between these two approaches.

中文翻译：

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冷冻消融与部分肾切除术治疗散发性肾脏肿瘤的孤立性肾结局：倾向评分分析

背景

虽然肾部分切除术（PN）被认为是孤立肾脏中肿瘤的标准治疗方法，但经皮冷冻消融（PCA）逐渐成为保留肾单位的替代选择。

客观的

为了比较孤立肾中PCA和PN对于肿瘤的结局。

设计，设置和参与者

使用Mayo Clinic Registries鉴定了2005年至2015年间在孤立肾脏中因单个原发性肾肿瘤接受过PCA或PN的患者。排除标准是遗传性肿瘤综合征和抢救程序。

干涉

PCA和PN。

成果测量和统计分析

为了达到基线特征的平衡，我们根据接受治疗的倾向使用了治疗加权比的倒数（IPTW）。比较两组间治疗后并发症的风险和估计的肾小球滤过率（eGFR）下降的百分比，以及局部/同侧复发，远处转移和癌症特异性死亡率的风险，采用逻辑，线性，和精细与灰色竞争风险回归模型。

结果与局限性

该队列包括118例患者（PCA：54； PN：64），中位随访时间为47 mo（四分位间距为18、74）。在未经校正的分析中，PCA与并发症风险较低相关（15％比31％；优势比[OR] = 0.38； 95％置信区间[CI] 0.15、0.96；p  = 0.04）。但是，考虑到IPTW调整后的基线差异，并发症风险不再存在显着差异（28％比29％； OR = 0.95； 95％CI 0.53，1.69；p  = 0.9）。出院时eGFR的百分比下降在PCA和PN之间没有显着差异（平均值：11％对16％；β  = –5％； 95％CI –13，3；p  = 0.2）或在3 mo（12％） vs 9％；β  = 3％； 95％CI –3，10; p = 0.3）。同样，在局部复发（HR = 0.87； 95％CI 0.38，1.98；p  = 0.7），远处转移（HR = 0.60； 95％CI 0.30，1.20；p  = 0.2）或癌症特异性方面，也未发现明显差异。死亡率（HR = 1.13； 95％CI 0.32，3.98；p  = 0.8）。考虑到孤立肾脏中肾脏肿块的相对稀有性，限制因素包括样本量。

结论

我们的研究发现，对于孤立肾中的肿瘤患者，PN和PCA在并发症，肾功能预后和肿瘤学预后方面无显着差异。可能需要在较大的多机构分析中进行验证。

病人总结

部分肾切除术（手术）和经皮冷冻消融术都是治疗肾脏肿瘤同时保留肾脏正常部分的两种选择。在仅有肾脏的肿瘤患者中，我们发现这两种方法在并发症风险，肾功能预后或癌症控制预后之间没有差异。