Tumor Growth Kinetics and Oncologic Outcomes of Patients Undergoing Active Surveillance for Residual Renal Tumor following Percutaneous Thermal Ablation

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• 作者：James X. Chen ; MD^a ; Daniel Maass ; BS^a ; Thomas J. Guzzo ; MD ; MPH^b ; S. Bruce Malkowicz ; MD^b ; Alan J. Wein ; MD^b ; Michael C. Soulen ; MD^a ; Timothy W.I. Clark ; MD^a ; Gregory J. Nadolski ; MD^a ; S. William Stavropoulos ; MD^a ; ^{stav@uphs.upenn.edu" class="auth_mail" title="E-mail the corresponding author}
• 关键词：AS ; active surveillance ; CCI ; Charlson Comorbidity Index ; RCC ; renal cell carcinoma ; VDT ; volume doubling time ; VGR ; volumetric growth rate
• 刊名：Journal of Vascular and Interventional Radiology
• 出版年：2016
• 出版时间：September 2016
• 年：2016
• 卷：27
• 期：9
• 页码：1397-1406
• 全文大小：714 K

文摘

To evaluate growth kinetics and oncologic outcomes of patients with renal tumors undergoing active surveillance (AS) for residual viable tumor following percutaneous ablation.

Materials and Methods

Following percutaneous thermal ablation, residual tumor was detected in 21/133 (16%) patients on initial follow-up imaging, and AS was undertaken in 17/21 (81%) patients. Initial tumor volumes and volumes after ablation were assessed from cross-sectional imaging to calculate volumetric growth rate (VGR) and volume doubling time (VDT) of residual tumor. The rate of metastasis, overall survival, and renal cell carcinoma (RCC)–specific survival were compared between patients in the AS group and in the routine follow up group of patients who did not have residual tumor.

Results

Median tumor volume prior to ablation, after first ablation, and at final follow-up were 25 cm³, 6 cm³, and 6 cm³, respectively, in patients with residual tumor. Stable, mild, and moderate VGR occurred in 8/17 (47%), 4/17 (24%), and 5/17 (29%) cases, respectively. The 4 cases with fastest VDT underwent delayed intervention with ablation (n = 1) and nephrectomy (n = 3) without subsequent residual, recurrence, or metastasis. There was no significant difference in the rates of RCC metastasis, overall survival, or RCC-specific survival between AS and routine follow-up groups. Metastatic RCC and subsequent death occurred in 1 patient in the AS group, after the patient had refused offers for retreatment for local progression over 60.7 months of follow-up.

Conclusions

In cases when patients are not amenable to further intervention, AS of residual tumor may be an acceptable alternative and allows for successful delayed intervention when needed.