Perioperative and oncological outcomes of incomplete thermal ablations with or without immediate retreatment for patients with small renal masses

IF 2.8 3区医学 Q3 ONCOLOGY

Urologic Oncology-seminars and Original Investigations Pub Date : 2026-02-01 Epub Date: 2025-11-23 DOI:10.1016/j.urolonc.2025.11.002

Letizia Maria Ippolita Jannello M.D. , Stefano Luzzago M.D. , Mattia Luca Piccinelli M.D. , Francesco A. Mistretta M.D. , Chiara Vaccaro M.D. , Marco Tozzi M.D. , Elena Lievore M.D. , Daniele Maiettini M.D. , Giovanni Cordima M.D. , Maria Giovanna Pitoni M.D. , Giulia Corrao M.D. , Paolo Della Vigna M.D. , Giulia Marvaso M.D. , Guido Bonomo M.D. , Barbara Alicja Jereczek-Fossa M.D., Ph.D. , Gennaro Musi M.D. , Franco Orsi M.D.

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引用次数: 0

Abstract

Objective

Thermal ablation (TA) offers an alternative to partial nephrectomy in treating small renal masses (SRMs). However, little is known about the perioperative outcomes of incomplete TA or the effects of re-ablation for residual masses.

Materials and Methods

We retrospectively analyzed 551 SRMs (cT1a-b) treated with TA at a single center (2008–2022). Apparent incomplete ablation was defined as contrast enhancement on a 24-hour computed tomography, while true incomplete ablation was confirmed by persistent enhancement at a 6-week follow-up. Multivariable logistic regression models assessed predictors of apparent incomplete ablation. Kaplan–Meier (KM) plots evaluated local recurrence rates (LRR), systemic recurrence (SR), cancer-specific survival (CSS), and overall survival (OS) in patients with complete vs. true incomplete ablation. Scatter plots analyzed renal function in single or multiple TA sessions. Finally, a sensitivity analysis was conducted for biopsy-proven renal cell carcinoma.

Results

Of 551 patients, 49 (8.9%) and 29 (5.2%) experienced apparent and true incomplete ablation, respectively. Predictors of apparent incomplete ablation included higher RENAL complexity (moderate odds ratio [OR]: 3.96, P < 0.001; high OR: 3.47, P = 0.026), larger tumors (OR: 1.69, P < 0.001), and greater comorbidity burden (age-adjusted Charlson Comorbidity Index OR: 1.27, P = 0.004). KM plots showed no differences in LRR (P = 0.79), SR (P = 0.19), CSS (P = 0.56), or OS (P = 0.14) between complete and true incomplete ablation groups. Of 29 patients with true incomplete ablation, 27 underwent re-ablation, with scatter plots showing no adverse effects of multiple TAs on kidney function. The sensitivity analysis restricted to biopsy-proven RCC (n = 438) confirmed the robustness of our findings.

Conclusion

Apparent incomplete ablation occurred in 8.9% of cases, but only 5.2% had true incomplete ablation requiring re-ablation. Multiple TA sessions were effective, renal function was preserved, and tumor-related outcomes were unaffected.

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小肾肿块患者不完全热消融伴或不伴立即再治疗的围手术期和肿瘤预后。

目的：热消融（TA）为治疗小肾肿块（SRMs）提供了一种替代部分肾切除术的方法。然而，对于不完全TA的围手术期结局或残余肿块再消融的影响知之甚少。材料和方法：我们回顾性分析了551例在单一中心（2008-2022）接受TA治疗的SRMs （cT1a-b）。明显的不完全消融被定义为24小时计算机断层扫描上的对比增强，而真正的不完全消融在6周的随访中被持续增强证实。多变量logistic回归模型评估了明显不完全消融的预测因素。Kaplan-Meier （KM）图评估完全消融与真正不完全消融患者的局部复发率（LRR）、全身复发率（SR）、癌症特异性生存率（CSS）和总生存率（OS）。散点图分析了单次或多次TA治疗的肾功能。最后，对活检证实的肾细胞癌进行敏感性分析。结果：551例患者中，49例（8.9%）和29例（5.2%）分别经历了明显和真实的不完全消融。明显不完全消融的预测因素包括更高的肾脏复杂性（中等优势比[OR]: 3.96, P < 0.001；高优势比：3.47,P = 0.026）、更大的肿瘤（OR: 1.69, P < 0.001）和更大的合并症负担（年龄校正Charlson合并症指数OR: 1.27, P = 0.004）。KM图显示完全消融组和真正不完全消融组的LRR （P = 0.79）、SR （P = 0.19）、CSS （P = 0.56）和OS （P = 0.14）均无差异。在29例真正不完全消融的患者中，27例再次消融，散点图显示多次ta对肾功能没有不良影响。敏感性分析仅限于活检证实的RCC (n = 438)，证实了我们研究结果的稳健性。结论：8.9%的病例出现了明显的不完全消融，但只有5.2%的病例出现了真正的不完全消融，需要再次消融。多次TA治疗有效，肾功能得以保留，肿瘤相关预后未受影响。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Urologic Oncology-seminars and Original Investigations 医学-泌尿学与肾脏学

CiteScore

4.80

自引率

3.70%

发文量

297

审稿时长

7.6 weeks

期刊介绍： Urologic Oncology: Seminars and Original Investigations is the official journal of the Society of Urologic Oncology. The journal publishes practical, timely, and relevant clinical and basic science research articles which address any aspect of urologic oncology. Each issue comprises original research, news and topics, survey articles providing short commentaries on other important articles in the urologic oncology literature, and reviews including an in-depth Seminar examining a specific clinical dilemma. The journal periodically publishes supplement issues devoted to areas of current interest to the urologic oncology community. Articles published are of interest to researchers and the clinicians involved in the practice of urologic oncology including urologists, oncologists, and radiologists.