医学
肾切除术
肾细胞癌
外科
肾功能
倾向得分匹配
优势比
混淆
逻辑回归
经皮
肿瘤科
危险系数
内科学
泌尿科
比例危险模型
置信区间
肾
作者
M. Brassier,Z. Khene,Bernhard Jost,V. Dang,I. Ouzaïd,F. Nouhaud,Jonathan Olivier,C. Nedelcu,N. Grenier,Luc Beuzit,N. Doumerc,Karim Bensalah,P. Bigot
标识
DOI:10.1016/j.euf.2021.02.007
摘要
Data comparing percutaneous ablation (PCA) and surgical resection (SR) for an isolated local recurrence (LR) following partial nephrectomy (PN) for renal cell carcinoma (RCC) are lacking.To examine the outcomes between PCA and SR for an isolated LR following PN for RCC.Patients who underwent PN for RCC and developed an LR between 2013 and 2019 were included. An LR was defined as the appearance of a mass in contact with the resection bed or the development of a tumor in the same region of the homolateral kidney as the original site.PCA or SR.To achieve balance in baseline characteristics, we used inverse probability of treatment weighting (IPTW) based on propensity to receive treatment. Oncological outcomes, complications, and renal function were evaluated between groups using logistic, linear, and Cox proportional hazard regression models.A total of 81 patients with an isolated LR were included (PCA: 42; SR: 39). The median follow-up was 23 mo. After adjustment, excellent balance was achieved for the majority of propensity score variables. In IPTW analysis, PCA was associated with a lower risk of postoperative complications (odds ratio=0.22; p=0.006) and a smaller change in eGFR (beta=-16.18; p=0.001). There were no significant differences in the risk of disease recurrence (hazard ratio [HR]=0.72; p=0.61), new LR (HR=1.51; p=0.59), and distant metastasis (HR=0.19; p=0.09). Limitations include the sample size and unmeasured confounding factors.Our results suggest that PCA provides comparable oncological outcomes to repeat surgery with fewer complications and better renal function preservation for the management of an LR after PN.This report shows that percutaneous ablation can be used for treating a local recurrence of renal cell carcinoma after partial nephrectomy, without significantly compromising cancer control.
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