微波消融与射频消融在小肾块治疗中的术中和肿瘤学结局对比

Microwave vs radiofrequency ablation for small renal masses: perioperative and oncological outcomes

BJU INTERNATIONAL

影响因子:4.4

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

DOI: 10.1111/bju.16528

摘要

为全面比较微波消融（MWA）与射频消融（RFA）在小肾块（SRMs）治疗中的效果，具体指标包括：三重成功（TRIFECTA，具体为[i] 完全消融，[ii] Clavien-Dindo Grade ≥III并发症的缺失，以及[iii] 估算肾小球滤过率（eGFR）降低≥30%的缺失）、手术时间（OT）及局部复发率（LRR）。我们回顾性分析了在单一中心（2008-2022）接受MWA或RFA治疗的531例SRMs患者（临床T1a-b）。首先，采用多变量逻辑回归模型检验TRIFECTA的达成情况；其次，使用多变量泊松回归模型评估影响OT的因素；最后，利用Kaplan-Meier曲线描绘随时间的LRR。所有分析在1:1倾向性评分匹配（PSM）后亦重复进行。在531例患者中，373例（70.2%）接受MWA，158例（29.8%）接受RFA。MWA在TRIFECTA达成率方面优于RFA（84.2%对72.2%，P=0.001），主要由更高的完全消融率驱动（93.3%对86.7%，P<0.001）。多变量逻辑回归分析显示，MWA在达成TRIFECTA方面优于RFA（比值比[OR] 1.92，P=0.008），在匹配后亦保持优势（OR 1.99，P=0.023）。中位手术时间MWA显著短于RFA（105分钟对115分钟，P=0.002）。泊松回归分析显示，MWA在匹配前（发病率比[IRR] 0.86，P<0.001）和匹配后（IRR 0.85，P<0.001）均能预测较短的手术时间。术后随访中，MWA组有17/373例（4.6%）发生局部复发，RFA组21/158例（13.3%），差异无统计学意义（P=0.29），随访中位数24个月（四分位间距8-46）。Kaplan-Meier曲线分析未显示两组在LRR上的差异（匹配前P=0.29，匹配后P=0.42）。综上，微波消融在TRIFECTA达成率和手术时间方面优于RFA，且两者在LRR方面无显著差异。

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.