Percutaneous cryoablation (PCA) can be an alternative to partial nephrectomy (PN) in selected patients with stage T1 renal tumours. Existing meta-analyses regarding ablative techniques compared both laparoscopic and PCA with PN. That is why we decided to perform a meta-analysis that focused solely on PCA. The aim of this study was to compare the complications and functional and oncological outcomes between PCA and PN. A systematic literature search was performed in January 2024. Data for dichotomous and continuous variables were expressed as pooled odds ratios (ORs) and mean differences (MDs), both with 95% confidence intervals (CIs). Effect measures for the local recurrence-free survival (LRFS), metastasis-free survival (MFS), cancer-specific survival (CSS) and overall survival (OS) were expressed as pooled hazard ratios with 95% CIs. Among 6487 patients included in the 14 selected papers, 1554 (23.9%) and 4924 (76.1%) underwent PCA and PN, respectively. Compared with the PN group, patients undergoing PCA had significantly lower overall and major postoperative complication rates. There was no difference in renal function between PCA and PN groups. When analysing collective data for cT1 renal carcinoma, PCA was associated with worse LRFS compared with PN. However, subgroup analysis revealed that in the case of PCA, LRFS was not decreased in patients with cT1a tumours. Moreover, patients undergoing robotic-assisted PN had improved LRFS compared with those undergoing PCA. No significant differences were observed between PCA and PN in terms of MFS and CSS. Finally, PCA was associated with worse OS than PN in both collective and subgroup analyses. In conclusion, PCA is associated with favourable postoperative complication rates relative to PN. Regarding LRFS, PCA is not worse than PN in cT1a tumours but has a substantially relevant disadvantage in cT1b tumours. Also, RAPN might be the only surgical modality that provides better LRFS than PCA. In cT1 tumours, PCA shows MFS and CSS comparable to PN. Lastly, PCA is associated with a shorter OS than PN.
对于部分T1期肾肿瘤患者，经皮冷冻消融术可作为肾部分切除术的替代治疗方案。现有关于消融技术的荟萃分析同时纳入了腹腔镜手术和经皮冷冻消融术与肾部分切除术的比较研究。因此，我们决定专门针对经皮冷冻消融术开展一项荟萃分析。本研究旨在比较经皮冷冻消融术与肾部分切除术在并发症、功能预后及肿瘤学结局方面的差异。我们于2024年1月进行了系统性文献检索。二分类变量和连续变量的数据分别以合并比值比和均数差表示，并均附有95%置信区间。局部无复发生存期、无转移生存期、癌症特异性生存期和总生存期的效应量以合并风险比及95%置信区间表示。在纳入的14篇文献共6487例患者中，分别有1554例（23.9%）和4924例（76.1%）接受了经皮冷冻消融术和肾部分切除术。与肾部分切除术组相比，接受经皮冷冻消融术的患者总体及主要术后并发症发生率显著更低。两组间肾功能无显著差异。在分析cT1期肾癌的汇总数据时，经皮冷冻消融术的局部无复发生存期较肾部分切除术更差。然而亚组分析显示，对于cT1a期肿瘤患者，经皮冷冻消融术并未降低其局部无复发生存期。此外，接受机器人辅助肾部分切除术的患者比接受经皮冷冻消融术的患者具有更好的局部无复发生存期。在无转移生存期和癌症特异性生存期方面，两组间未观察到显著差异。最后，在汇总分析和亚组分析中，经皮冷冻消融术的总生存期均较肾部分切除术更差。综上所述，与肾部分切除术相比，经皮冷冻消融术具有更优的术后并发症发生率。在局部无复发生存期方面，对于cT1a期肿瘤，经皮冷冻消融术不劣于肾部分切除术，但在cT1b期肿瘤中存在明显劣势。此外，机器人辅助肾部分切除术可能是唯一能提供优于经皮冷冻消融术的局部无复发生存期的手术方式。对于cT1期肿瘤，经皮冷冻消融术的无转移生存期和癌症特异性生存期与肾部分切除术相当。最后，经皮冷冻消融术的总生存期短于肾部分切除术。
肿瘤(癌症)患者之家