PDF(Pubmed)
Abstract：
OBJECTIVE: To evaluate the effectiveness of cryoablation compared to partial nephrectomy in patients with stage IA papillary and chromophobe renal cell carcinoma (pRCC; chRCC).
METHODS: The 2004-2016 National Cancer Database was queried for adult patients with stage IA pRCC or chRCC treated with cryoablation or partial nephrectomy. Patients receiving systemic therapy or radiotherapy, as well as those with bilateral RCC or prior malignant disease were excluded. Overall survival (OS) was assessed using Kaplan-Meier plots and Cox proportional hazard regression models. Nearest neighbor propensity matching (1:1 cryoablation:partial nephrectomy, stratified for pRCC and chRCC) was used to account for potential confounders.
RESULTS: A total of 11122 stage IA renal cell carcinoma patients were included (pRCC 8030; chRCC 3092). Cryoablation was performed in 607 (5.5%) patients, and partial nephrectomy in 10515 (94.5%) patients. A higher likelihood of cryoablation treatment was observed in older patients with non-private healthcare insurance, as well as in those with smaller diameter low-grade pRCC treated at non-academic centers in specific US geographic regions. After propensity score matching to account for confounders, there was no statistically significant difference in OS comparing cryoablation vs partial nephrectomy in patients with pRCC (HR = 1.3, 95% CI: 0.96-1.75, p = 0.09) and those with chRCC (HR = 1.38, 95% CI: 0.67-2.82, p = 0.38).
CONCLUSIONS: After accounting for confounders, cryoablation, and partial nephrectomy demonstrated comparable OS in patients with stage IA papillary and chromophobe RCC. Cryoablation is a reasonable treatment alternative to partial nephrectomy for these histological RCC subtypes when radiologically suspected or diagnosed after biopsy.
UNASSIGNED: Cryoablation might be considered as an upfront treatment alternative to partial nephrectomy in patients with papillary and chromophobe stage IA renal cell carcinoma, as both treatment approaches yield comparable oncological outcomes.
CONCLUSIONS: The utilization of cryoablation for stage IA papillary and chromophobe RCC increases. In the National Cancer Database, we found specific patterns of use of cryoablation. Cryoablation and partial nephrectomy demonstrate comparable outcomes after accounting for confounders.
METHODS: The 2004-2016 National Cancer Database was queried for adult patients with stage IA pRCC or chRCC treated with cryoablation or partial nephrectomy. Patients receiving systemic therapy or radiotherapy, as well as those with bilateral RCC or prior malignant disease were excluded. Overall survival (OS) was assessed using Kaplan-Meier plots and Cox proportional hazard regression models. Nearest neighbor propensity matching (1:1 cryoablation:partial nephrectomy, stratified for pRCC and chRCC) was used to account for potential confounders.
RESULTS: A total of 11122 stage IA renal cell carcinoma patients were included (pRCC 8030; chRCC 3092). Cryoablation was performed in 607 (5.5%) patients, and partial nephrectomy in 10515 (94.5%) patients. A higher likelihood of cryoablation treatment was observed in older patients with non-private healthcare insurance, as well as in those with smaller diameter low-grade pRCC treated at non-academic centers in specific US geographic regions. After propensity score matching to account for confounders, there was no statistically significant difference in OS comparing cryoablation vs partial nephrectomy in patients with pRCC (HR = 1.3, 95% CI: 0.96-1.75, p = 0.09) and those with chRCC (HR = 1.38, 95% CI: 0.67-2.82, p = 0.38).
CONCLUSIONS: After accounting for confounders, cryoablation, and partial nephrectomy demonstrated comparable OS in patients with stage IA papillary and chromophobe RCC. Cryoablation is a reasonable treatment alternative to partial nephrectomy for these histological RCC subtypes when radiologically suspected or diagnosed after biopsy.
UNASSIGNED: Cryoablation might be considered as an upfront treatment alternative to partial nephrectomy in patients with papillary and chromophobe stage IA renal cell carcinoma, as both treatment approaches yield comparable oncological outcomes.
CONCLUSIONS: The utilization of cryoablation for stage IA papillary and chromophobe RCC increases. In the National Cancer Database, we found specific patterns of use of cryoablation. Cryoablation and partial nephrectomy demonstrate comparable outcomes after accounting for confounders.
摘要：
目的：评价冷冻消融术与肾部分切除术治疗IA期乳头状和嫌色细胞肾细胞癌(pRCC;chRCC)的疗效。
方法：在2004-2016年国家癌症数据库中查询了接受冷冻消融或部分肾切除术治疗的IApRCC或chRCC期成年患者。接受全身治疗或放疗的患者，以及患有双侧RCC或先前恶性疾病的患者被排除。使用Kaplan-Meier图和Cox比例风险回归模型评估总生存期(OS)。最近邻居倾向匹配(1:1冷冻消融:肾部分切除术,pRCC和chRCC分层）用于解释潜在的混杂因素。
结果：共纳入11122例IA期肾细胞癌患者（pRCC8030；chRCC3092）。607例（5.5%）患者进行冷冻消融，10515例（94.5%）患者进行肾部分切除术。在非私人医疗保险的老年患者中观察到冷冻消融治疗的可能性更高，以及在美国特定地理区域的非学术中心治疗的直径较小的低度pRCC。在倾向得分匹配以解释混杂因素之后，在pRCC患者(HR=1.3,95%CI:0.96-1.75,p=0.09)和chRCC患者(HR=1.38,95%CI:0.67-2.82,p=0.38)中,冷冻消融术与肾部分切除术的OS比较差异无统计学意义.
结论：在考虑混杂因素后，冷冻消融,在IA期乳头状和发色细胞RCC患者中，部分肾切除术显示出相当的OS。当放射学怀疑或活检后诊断为这些组织学RCC亚型时，冷冻消融是一种合理的替代肾部分切除术的治疗方法。
■冷冻消融术可能被认为是乳头状和发色细胞IA期肾细胞癌患者部分肾切除术的前期治疗替代方案，因为两种治疗方法都能产生可比的肿瘤结局。
结论：冷冻消融治疗IA期乳头状和发色细胞RCC的利用率增加。在国家癌症数据库中，我们发现了冷冻消融的具体使用模式.冷冻消融术和肾部分切除术在考虑混杂因素后显示出相当的结果。
方法：在2004-2016年国家癌症数据库中查询了接受冷冻消融或部分肾切除术治疗的IApRCC或chRCC期成年患者。接受全身治疗或放疗的患者，以及患有双侧RCC或先前恶性疾病的患者被排除。使用Kaplan-Meier图和Cox比例风险回归模型评估总生存期(OS)。最近邻居倾向匹配(1:1冷冻消融:肾部分切除术,pRCC和chRCC分层）用于解释潜在的混杂因素。
结果：共纳入11122例IA期肾细胞癌患者（pRCC8030；chRCC3092）。607例（5.5%）患者进行冷冻消融，10515例（94.5%）患者进行肾部分切除术。在非私人医疗保险的老年患者中观察到冷冻消融治疗的可能性更高，以及在美国特定地理区域的非学术中心治疗的直径较小的低度pRCC。在倾向得分匹配以解释混杂因素之后，在pRCC患者(HR=1.3,95%CI:0.96-1.75,p=0.09)和chRCC患者(HR=1.38,95%CI:0.67-2.82,p=0.38)中,冷冻消融术与肾部分切除术的OS比较差异无统计学意义.
结论：在考虑混杂因素后，冷冻消融,在IA期乳头状和发色细胞RCC患者中，部分肾切除术显示出相当的OS。当放射学怀疑或活检后诊断为这些组织学RCC亚型时，冷冻消融是一种合理的替代肾部分切除术的治疗方法。
■冷冻消融术可能被认为是乳头状和发色细胞IA期肾细胞癌患者部分肾切除术的前期治疗替代方案，因为两种治疗方法都能产生可比的肿瘤结局。
结论：冷冻消融治疗IA期乳头状和发色细胞RCC的利用率增加。在国家癌症数据库中，我们发现了冷冻消融的具体使用模式.冷冻消融术和肾部分切除术在考虑混杂因素后显示出相当的结果。
