Abstract

Purpose

Radiofrequency and cryoablation (Cryo) are the most widely used techniques for the treatment of T1a renal tumors in non-surgical candidates, yet microwave ablation (MWA) has been gaining popularity. In this study, we tested the hypothesis that MWA has comparable safety and efficacy to Cryo in the treatment of selected T1a renal masses.

Materials and Methods

A retrospective comparative analysis of two patient cohorts was carried out on 83 nodules in 72 consecutive patients treated using image-guided percutaneous ablation with either Cryo or MWA. Patient demographics, tumor histology and characteristics, technical success, procedure time, adverse events and complications, nephrometry score (mRENAL) and renal function were evaluated. Local recurrence was evaluated at 1, 6, 12 and 18–24 months.

Results

Fifty-one nodules were treated with Cryo and 32 with MWA (44 and 28 patients, respectively). No statistical differences were observed following Cryo or MWA in median tumor size (p = 0.6), mRENAL (p = 0.1) or technical success (p = 0.8). Median procedure time was significantly lower using microwave ablation (p = 0.003). Median follow-up time was similar in the two groups (22 and 20 months, respectively). Occurrence of complications did not differ (Cryo 5/51, MWA 2/32; p = 0.57), and probability of complications or technical success adjusted for mRENAL did not reach statistical significance (p = 0.6). Renal function was preserved in all patients regardless of techniques. Disease recurrence was observed in 3/47 and in 1/30 treated nodules in the Cryo and MWA groups, respectively, without reaching statistical significance (p = 0.06).

Conclusion

In the patient population studied, MWA showed comparable safety and efficacy relative to Cryo.

Level of Evidence

Level 3, Non-randomized cohort study.

中文翻译：

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经皮微波消融与冷冻消融治疗T1a肾肿瘤

摘要

目的

射频和冷冻消融（Cryo）是在非手术候选者中治疗T1a肾肿瘤的最广泛使用的技术，然而微波消融（MWA）已获得普及。在这项研究中，我们检验了以下假设：MWA在选择的T1a肾肿块的治疗中具有与Cryo相当的安全性和有效性。

材料和方法

回顾性比较分析了72例连续患者中83个结节的回顾性比较分析，这些患者均使用影像引导的经皮冷冻或MWA消融治疗。评估患者的人口统计学资料，肿瘤组织学和特征，技术成功率，手术时间，不良事件和并发症，肾功能评分（mRENAL）和肾功能。在1、6、12和18-24个月评估局部复发。

结果

用冰冻冷冻治疗51个结节，用MWA治疗32个结节（分别为44例和28例）。在冷冻或MWA治疗后，中位肿瘤大小（p  = 0.6），mRENAL（p  = 0.1）或技术成功率（p  = 0.8）未见统计学差异。使用微波消融术的中位手术时间明显缩短（p  = 0.003）。两组的中位随访时间相似（分别为22个月和20个月）。并发症的发生率无差异（Cryo 5/51，MWA 2/32；p  = 0.57），针对mRENAL进行调整的并发症发生率或技术成功率未达到统计学显着性（p = 0.6）。无论采用何种技术，所有患者的肾功能均得以保留。在Cryo和MWA组中，分别在3/47和1/30治疗的结节中观察到疾病复发，但未达到统计学显着性（p  = 0.06）。

结论

在研究的患者人群中，MWA显示出与冷冻疗法相当的安全性和疗效。

证据水平

第3级，非随机队列研究。