动脉栓塞联合冷冻消融治疗中晚期肾癌临床疗效

Clinical efficacy advanced renal of transcatheter renal arterial embolization plus cryoablation for medium and carcinomas

目的探讨肾动脉栓塞（TRAE）与氩氦冷冻消融联合治疗中晚期肾癌的临床疗效。方法2004年12月至2009年12月，对天津医科大学附属天津肿瘤医院肿瘤介入治疗科收治的临床资料和随访完整的104例中晚期肾癌患者进行回顾性研究。104例中晚期肾癌患者分为两组：（1）TRAE与冷冻消融联合治疗组51例，在TRAE治疗后2～3周，接受冷冻消融治疗。（2）单纯TRAE组53例。肿瘤最大径4．0～19．8cm，平均（8．7±3．2）cm，总计128个瘤块，均以肿瘤最大径为观察目标。观察治疗前后患者临床症状、肾功能、肿瘤影像学（CT或MRI）变化，以评估治疗后肿瘤坏死和生存预后。结果两组病例的性别、年龄、病灶大小、肿瘤Robson分期差异无统计学意义。TRAE与冷冻消融联合组的肿瘤坏死率为61％±9％，单纯TRAE组为35％±8％，两组比较差异有统计学意义（t=6．784，P〈0．01）。联合组中位生存期为（24个月），明显高于TRAE组（15个月），二者差异有统计学意义（P〈0．01）。治疗前后两组患者肾功能均未见明显变化，治疗前后差异无统计学意义（P〉0．05）；两组患者治疗后生活质量评分均较治疗前有所提高（P〈0．01）。结论TRAE与冷冻消融联合治疗晚期肾癌的疗效明显优于单纯TRAE，可提高肿瘤坏死率并延长患者生存期。

Objective To investigate the clinical efficacy of transcatheter renal arterial embolization （TRAE） plus cryoablation in the treatment of medium and advanced stage renal carcinomas. Methods The patients with medium and advanced stage renal carcinomas were randomized into 2 groups ： TRAE group （ A, n = 53 ） and TRAE plus cryoablation group （ B, n = 51 ） undergoing cryoablation 2 - 3 weeks after TRAE. A total of 128 tumors （8.7 ± 3.2） （4.0 - 19. 8） cm in diameter were detected. And the largest tumor in a specific patient with multiple lesions was selected for observation. At pre- and post-treatment, their clinical symptoms, kidney function and tumor diameters （computed tomography or magnetic resonance imaging） were observed. And their post-treatment profiles of tumor necrosis and survival were assessed. Results There was no difference in gender, age, size and Robson stage between two groups. The tumor necrosis of Group B was significantly higher than that of Group A （61% vs 35%, t = 6. 784, P 〈 0. 01 ）. The median survival duration of Group B was significantly longer than that of Group A （ 24 vs 15 months, P 〈 0. 05 ）. There was no significant change of kidney function at pre- and post-treatment （ P 〉 0.05 ）. The quality-of-life scores improved at post-treatment （P 〈 0. 01 ）. Conclusion As compared with TRAE therapy alone, the combination of TRAE and cryoablation may improve the tumor necrosis rate and prolong the patient survival duration.