对微波消融 (MWA) 与射频消融 (RFA) 治疗小肾肿块 (SRM) 的结果进行全面比较，特别是：TRIFECTA（[i] 完全消融，[ii] 不存在 Clavien-Dindo 等级 ≥ III） [iii] 预计肾小球滤过率、手术时间 (OT) 和局部复发率 (LRR) 未降低 ≥30%。我们回顾性分析了 531 例接受 MWA 治疗的 SRM（临床 T1a-b）患者或在单一中心进行 RFA（2008-2022 年）。首先，使用多变量逻辑回归模型来测试 TRIFECTA 成绩。其次，使用多变量泊松回归模型来评估与较长 OT 相关的变量。最后，Kaplan-Meier 图描绘了随时间变化的 LRR。所有分析均在 1:1 倾向评分匹配 (PSM) 后重复进行。在 531 名 SRM 患者中，373/531 (70.2%) 接受了 MWA，158/531 (29.8%) 接受了 RFA。与 RFA (114/158 [72.2%]，P = 0.001) 相比，MWA 表现出优异的 TRIFECTA 成绩 (314/373 [84.2%])。这些差异是由于 MWA 治疗患者与 RFA 治疗患者的完全消融率较高所致（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，在 PSM 之前（比值比 [OR] 1.92，P = 0.008）和 PSM 后（OR 1.99，P = 0.023），MWA 与更高的 TRIFECTA 成绩相关。最后，MWA 与 RFA 相比，中位 OT 更短（105 分钟 vs 115 分钟；P=0.002）。在泊松回归分析中，MWA 预测 PSM 之前（发生率比 [IRR] 0.86，P < 0.001）和 PSM 后（IRR 0.85，P < 0.001）后 OT 会缩短。中位（四分位距）随访 24 (8-46)  个月后，17/373 (4.6%) MWA 治疗患者和 21/158 (13.3%) RFA 治疗患者发生局部复发 (P = 0.29) 。 Kaplan-Meier 图的 LRR 在 PSM 之前 (P = 0.29) 和 PSM 后 (P = 0.42) 没有差异。微波消融提供了更高的 TRIFECTA 效果，并且比 RFA 更短的 OT。 LRR 没有发现显着差异。© 2024 BJU International。

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.© 2024 BJU International.