Review

消融是否适用于小肾块？一项Meta分析

Is Ablation Suitable For Small Renal Masses? A Meta-Analysis

ACADEMIC RADIOLOGY

影响因子:3.9

分区:医学2区 / 核医学2区

发表日期:2025 Jan

作者: Si Ge, Zuoping Wang, Yunxiang Li, Lei Zheng, Lijian Gan, Zhiqiang Zeng, Chunyang Meng, Kangsen Li, Jiakai Ma, Deyu Wang, Yuan Ren

DOI: 10.1016/j.acra.2024.08.007

摘要

本Meta分析旨在比较小肾块（SRMs）中消融与部分肾切除术的围手术期和肿瘤学结局。我们严格按照PRISMA标准进行Meta分析，质量评估遵循AMSTAR标准。系统检索了Embase、PubMed、Cochrane图书馆和Web of Science四个数据库，检索时间范围自数据库创建至2023年11月。采用Stata16统计软件进行统计分析。连续变量采用加权均差（WMD）表示，二分类变量采用比值比（OR）或相对危险度（RR），并计算95%置信区间（95%CI）。共纳入27项研究，涉及6030例患者。结果显示，接受部分肾切除的患者年龄较小（WMD=-5.45岁，95%CI [-7.44, -3.46]，P<0.05），手术时间更长（WMD=64.91分钟，95%CI [44.47, 85.34]，P<0.05），住院时间更长（WMD=2.91天，95%CI [2.04, 3.78]，P<0.05），估算出血量更多（WMD=97.76毫升，95%CI [69.48, 126.04]，P<0.05），总体并发症发生率更高（OR=1.84，95%CI [1.48, 2.29]，P<0.05），严重并发症发生率更高（OR=1.98，95%CI [1.36, 2.88]，P<0.05），复发率更低（OR=0.32，95%CI [0.20, 0.50]，P<0.05）。然而，在癌症特异性生存（CSS）（HR=2.07，95%CI [0.61, 7.04]，P>0.05）、总生存（OS）（HR=1.24，95%CI [0.58, 2.65]，P>0.05）以及无复发生存（RFS）（HR=2.68，95%CI [0.91, 7.88]，P>0.05）方面，消融与部分肾切除没有显著差异。接受部分肾切除的患者年龄较小，手术时间和住院时间较长，且并发症发生率较高。然而，二者在CSS、OS和RFS方面没有显著差异，但仍需更多设计良好、高质量的研究以确认这些结果。

Abstract

To compare perioperative and oncology outcomes of ablation and partial nephrectomy in small renal masses (SRMs).We conduct this meta-analysis strictly according to the PRISMA standard, and the quality evaluation follows the AMSTAR standard. Four databases, Embase, PubMed, Cochrane Library, and Web of Science, were systematically searched. The search time range is from database creation to November 2023. Stata16 statistical software was used for statistical analysis. Weighted mean difference (WMD) represented continuity variables, odds ratio or relative risk (OR/RR) represented dichotomies variables, and 95% confidence intervals (95%CI) were calculated.A total of 27 studies, including 6030 patients. Results showed that patients undergoing partial nephrectomy were younger (WMD = -5.45 years, 95%CI [-7.44, -3.46], P < 0.05), had longer operation time (WMD = 64.91 min, 95%CI [44.47, 85.34], P < 0.05), had longer length of stay (WMD = 2.91 days, 95%CI [2.04, 3.78], P < 0.05), and had more estimated blood loss (WMD = 97.76 ml, 95%CI [69.48, 126.04]. P < 0.05), the overall complication rate was higher (OR = 1.84, 95%CI [1.48, 2.29], P < 0.05), the major complication rate was higher (OR = 1.98, 95%CI [1.36, 2.88], P < 0.05), and the recurrence rate was lower (OR = 0.32, 95%Cl [0.20, 0.50], P < 0.05). However, there were no differences between ablation and partial nephrectomy in cancer-specific survival (CSS) (HR = 2.07, 95%CI [0.61, 7.04], P > 0.05), overall survival (OS) (HR = 1.24, 95%CI [0.58, 2.65], P > 0.05), and recurrence-free survival (RFS) (HR = 2.68, 95%CI [0.91, 7.88], P > 0.05).Patients undergoing partial nephrectomy are younger, have longer operation time and length of stay, and have higher complication rate. However, there was no significant difference in CSS, OS, and RFS between partial nephrectomy and ablation, but more well-designed, high-quality studies are needed to confirm this.