Objectives

To assess the safety and efficacy of percutaneous microwave ablation (MWA) of histologically proven T1 renal cell carcinoma (RCC).

Methods

We analysed patients with a histologically proven RCC (≤ 7 cm) treated by MWA from April 2012–April 2018. Primary and secondary efficacy, local tumour recurrence (LTR), morbidity and mortality were reported. Efficacy was defined as no residual tumour enhancement on follow-up imaging 1 month after the first ablation (primary efficacy) and after re-ablation(s) for residual disease (secondary efficacy). Adverse events (AE) were registered by the Clavien–Dindo classification and the common terminology criteria for AE. Univariable and multivariable logistic regression analyses were performed to investigate a relation among pre-treatment factors incomplete ablation and complications.

Results

In 100 patients, a total of 108 RCCs (85 T1a and 23 T1b) were treated by MWA. Median size was 3.2 cm (IQR 2.4–4.0). Primary efficacy was 89% (95%CI 0.81–0.94) for T1a lesions and 52% (95%CI 0.31–0.73) for T1b lesions (p < 0.001). Fifteen lesions (7 T1a) were re-ablated for residual disease by MWA in one (n = 13) and two (n = 2, both T1b) sessions resulting in secondary efficacy rates of 99% (T1a) and 95% (T1b, p = 0.352). LTR occurred in four tumours (2 T1a, 2 T1b) after 10–60 months. Six (4%) AEs grade > 3–5 were observed (2 T1a, 4 T1b, p = 0.045). Multivariable analysis showed that mR.E.N.A.L. nephrometry was independently associated with incomplete ablation (p = 0.012).

Conclusion

Microwave ablation is safe and effective for T1a and T1b RCC lesions with a significantly lower primary efficacy for T1b lesions.

中文翻译：

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经组织学证实的T1肾细胞癌的经皮微波消融。

目标

评估经组织学证实的T1肾细胞癌（RCC）的经皮微波消融（MWA）的安全性和有效性。

方法

我们分析了2012年4月至2018年4月接受MWA治疗并经组织学证实为RCC（≤7 cm）的患者。报道了主要和次要疗效，局部肿瘤复发（LTR），发病率和死亡率。疗效定义为：第一次消融后1个月（主要疗效）和再次消融残余病灶（次要疗效）后随访影像检查未发现残余肿瘤增强。不良事件（AE）通过Clavien-Dindo分类和AE的通用术语标准进行记录。进行单变量和多变量logistic回归分析以研究治疗前因素不完全消融与并发症之间的关系。

结果

在100例患者中，MWA共治疗了108个RCC（85个T1a和23个T1b）。中位尺寸为3.2厘米（IQR 2.4-4.0）。对于T1a病变，主要疗效为89％（95％CI 0.81-0.94），对于T1b病变为52％（95％CI 0.31-0.73）（p  <0.001）。一次（n  = 13）和两次（n  = 2，两个T1b）疗程通过MWA重新消融了15个病变（7 T1a）的残留病，导致次要有效率为99％（T1a）和95％（T1b），p  = 0.352）。10-60个月后，LTR发生在四个肿瘤（2个T1a，2个T1b）中。观察到六种（4％）AE等级> 3-5（2 T1a，4 T1b，p  = 0.045）。多变量分析显示，mR.ENAL肾功能独立与消融不完全相关（p  = 0.012）。

结论

微波消融对T1a和T1b RCC病变是安全有效的，而对T1b病变的主要疗效则明显较低。