微波炉与小肾脏肿块的射频消融：围手术期和肿瘤学结果
Microwave vs radiofrequency ablation for small renal masses: perioperative and oncological outcomes
影响因子:4.40000
分区:医学2区 / 泌尿学与肾脏学2区
发表日期:2025 Jan
作者:
Letizia Maria Ippolita Jannello, Franco Orsi, Stefano Luzzago, Giovanni Mauri, Francesco A Mistretta, Mattia Luca Piccinelli, Chiara Vaccaro, Marco Tozzi, Daniele Maiettini, Gianluca Varano, Stefano Caramella, Paolo Della Vigna, Matteo Ferro, Guido Bonomo, Zhe Tian, Pierre I Karakiewicz, Ottavio De Cobelli, Gennaro Musi
摘要
进行微波消融（MWA）与射频消融（RFA）的全面比较，在较小的肾脏肿块（SRMS）治疗中，具体：trifecta（[i]完全消融，[ii] clavien-dindo级并发估计的估计均不含[ii] / [ii]均不含[iiii]的估计。成就，手术时间（OT）和局部复发率（LRR）。我们回顾性分析了531例在单个中心用MWA或RFA治疗的SRMS（临床T1A-B）患者（2008-2022）。首先，多变量逻辑回归模型用于测试Trifecta成就。其次，多变量泊松回归模型用于评估与较长ot相关的变量。最后，Kaplan-Meier情节随着时间的流逝描绘了LRR。 1：1倾向得分匹配（PSM）后，将重复所有分析。531例SRMS患者，373/531（70.2％）接受了MWA和158/531（29.8％）RFA。与RFA相比，MWA表现出了优越的Trifecta成就（314/373 [84.2％]）（114/158 [72.2％]，P = 0.001）。这些差异是由MWA-与RFA治疗的患者完全消融率较高的驱动的（348/373 [93.3％] vs 137/158 [86.7％]，p <0.001）。在多变量逻辑回归模型中，与RFA相比，MWA与较高的Trifecta成就相关联（优势比[OR] 1.92，P = 0.008）和PSM之后（OR 1.99，P = 0.023）。最后，MWA vs RFA的中位数较短（105 vs 115分钟； P = 0.002）。在Poisson回归分析时，MWA预测OT较短（发病率比[IRR] 0.86，p <0.001）和PSM之后（IRR 0.85，p <0.001）。经过24（8-46）月的中位随访（8-46）后，经过17/373（4.6％）MWA治疗的患者（4.6％）（4.6％）MWA治疗的患者（13.3％）RFA治疗的患者（P = 0.29）。在Kaplan-Meier图（p = 0.29）之前和PSM之后（p = 0.42）之前，LRR没有差异。Microwave消融可提供比RFA更高的Trifecta实现，而OT更短。在LRR方面没有发现显着差异。
Abstract
To conduct a comprehensive comparison of microwave ablation (MWA) vs radiofrequency ablation (RFA) outcomes in the treatment of small renal masses (SRMs), specifically: TRIFECTA ([i] complete ablation, [ii] absence of Clavien-Dindo Grade ≥III complications, and [iii] absence of ≥30% decrease in estimated glomerular filtration rate) achievement, operative time (OT), and local recurrence rate (LRR).We retrospectively analysed 531 patients with SRMs (clinical T1a-b) treated with MWA or RFA at a single centre (2008-2022). First, multivariable logistic regression models were used for testing TRIFECTA achievement. Second, multivariable Poisson regression models were used to evaluate variables associated with longer OT. Finally, Kaplan-Meier plots depicted LRR over time. All analyses were repeated after 1:1 propensity score matching (PSM).Of 531 patients with SRMs, 373/531 (70.2%) underwent MWA and 158/531 (29.8%) RFA. MWA demonstrated superior TRIFECTA achievement (314/373 [84.2%]) compared to RFA (114/158 [72.2%], P = 0.001). These differences were driven by higher rates of complete ablation in MWA- vs RFA-treated patients (348/373 [93.3%] vs 137/158 [86.7%], P < 0.001). In multivariable logistic regression models, MWA was associated with higher TRIFECTA achievement, compared to RFA, before (odds ratio [OR] 1.92, P = 0.008) and after PSM (OR 1.99, P = 0.023). Finally, the median OT was shorter for MWA vs RFA (105 vs 115 min; P = 0.002). At Poisson regression analyses, MWA predicted shorter OT before (incidence rate ratio [IRR] 0.86, P < 0.001) and after PSM (IRR 0.85, P < 0.001). Local recurrence occurred in 17/373 (4.6%) MWA-treated patients and 21/158 (13.3%) RFA-treated patients (P = 0.29) after a median (interquartile range) follow-up of 24 (8-46) months. There were no differences in the LRR in Kaplan-Meier plots before (P = 0.29) and after PSM (P = 0.42).Microwave ablation provides higher TRIFECTA achievement, and shorter OT than RFA. No significant differences were found regarding the LRR.