Assessment of local tumor ablation and non-interventional management versus partial nephrectomy in T1a renal cell carcinoma

Palumbo, Carlotta; Mistretta, F.A.; Knipper, Sophie; Mazzone, Elio; Pecoraro, Angela; Tian, Zhe; Perrotte, Paul; Antonelli, Alessandro; Montorsi, Francesco; Shariat, Shahrokh F.; Saad, Fred; Simeone, Claudio; Briganti, Alberto; Lavallée, Luke T.; Karakiewicz, Pierre I.

doi:10.23736/s0393-2249.19.03496-9

Cited by 17 publications

(4 citation statements)

References 23 publications

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“…Indeed, it is known that OCM accounts for most mortalities in T1a RCC patients. 13,14 In consequence, a large attrition effect from high OCM rates may reduce the sample size of patients at risk of CSM and, therefore, shine a favorable light on CSM outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…Specifically, adjustment for OCM is of pivotal importance in T1a RCC, where absolute CSM rates are very low but absolute OCM rates are much higher. 13,14 We tested these hypotheses in the most contemporary Surveillance, Epidemiology, and End Results (SEER) database (2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016)(2017)(2018).…”

Section: Figurementioning

confidence: 99%

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Cancer-specific Mortality After Cryoablation vs Heat-based Thermal Ablation in T1a Renal Cell Carcinoma

et al. 2023

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Study Need and Importance: Both cryoablation (CA) and heat-based thermal ablation (hTA) represent alternative management options for frail and/or comorbid T1a renal cell carcinoma patients when curative intent is sought, according to the current National Comprehensive Cancer Network guidelines. Conversely, the European Association of Urology guidelines recommend CA over hTA in patients with tumor size 3.1-4 cm, while either technique is recommended for those with tumor size 3 cm. The distinction between National Comprehensive Cancer Network vs European Association of Urology recommendations for patients with tumor size 3.1-4 cm is based on a very limited amount of data, mostly originating from case series. Our analyses distinguished themselves from previous reports by propensity score matching (PSM) and competing risks regression (CRR) adjusted for other-cause mortality, which accounts for most mortalities in T1a patients who are candidates for tumor ablation. What We Found: In patients with tumor size 3.1-4 cm, after up to 2:1 PSM that resulted in 757 CAs vs 388 hTAs, the 8-year cancer-specific mortality (CSM) rate was 8.5% vs 12.9% (see Figure ). In multivariable CRR models, hTA was associated with higher CSM (HR:2.02, P < .001) relative to CA. In patients with tumor size 3 cm, after up to 2:1 PSM that resulted in 2,217 CAs vs 1,114 hTAs, the 8-year CSM rate was 6.8% vs 6.1%. In multivariable CRR models, hTA was not associated with higher CSM (HR:1.13, P [ .5) relative to CA. Limitations: The retrospective nature and lack of data on earlier cancer control endpoints, such as local recurrence and/or disease-free survival, are limitations. Moreover, lack of information about retreatment, comorbidities, number of tumors, tumor location within the kidney, and type of ablation approach (percutaneous or laparoscopic) were missing but nondifferentially influenced both groups. Interpretation for Patient Care: In patients with tumor size 3.1-4 cm, hTA was associated with a twofold CSM disadvantage, relative to CA. Conversely, in patients with tumor size 3 cm, either ablation technique was equally valid.

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Section: Discussionmentioning

confidence: 99%

Section: Figurementioning

confidence: 99%

Cancer-specific Mortality After Cryoablation vs Heat-based Thermal Ablation in T1a Renal Cell Carcinoma

et al. 2023

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“…Even though the number of suspicious renal masses diagnosed every year in Germany has increased [ 24 ], the overall number of nephrectomy cases that are performed every year has remained stable in recent years [ 25 , 26 ]. The latter might be explained by the fact that an increasing number of patients with diagnosed renal masses undergo active surveillance or other ablative techniques [ 27 , 28 , 29 , 30 ]. Moreover, the fact that partial nephrectomy cases have increased by 300% while radical nephrectomy cases have decreased by 40% over the years might indicate that renal cancer is often diagnosed at less-advanced tumor stages.…”

Section: Discussionmentioning

confidence: 99%

Surgical Trends and Complications in Partial and Radical Nephrectomy: Results from the GRAND Study

Pyrgidis,

Schulz,

Stief

et al. 2023

Cancers

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Background: We aimed to evaluate the current trends in renal cancer surgery, as well as to compare the perioperative outcomes of partial versus radical nephrectomy. Methods: We used the GeRmAn Nationwide inpatient Data (GRAND), provided by the Research Data Center of the Federal Bureau of Statistics (2005–2021). We report the largest study in the field, with 317,843 patients and multiple patient-level analyses. Results: Overall, 123,924 (39%) patients underwent partial and 193,919 (61%) underwent radical nephrectomy in Germany from 2005 to 2021. Of them, 57,308 (18%) were operated on in low-, 142,702 (45%) in intermediate-, and 117,833 (37%) in high-volume centers. A total of 249,333 (78%) patients underwent open, 44,994 (14%) laparoscopic, and 23,516 (8%) robotic nephrectomy. The number of patients undergoing renal surgery remained relatively stable from 2005 to 2021. Over the study period, the utilization of partial nephrectomy increased threefold, while radical nephrectomy decreased by about 40%. After adjusting for major risk factors in the multivariate regression analysis, radical nephrectomy was associated with 3.2-fold higher odds (95% CI: 3.2 to 3.9, p < 0.001) of 30-day mortality, longer hospitalization by 1.9 days (95% CI: 1.9 to 2, p < 0.001), and higher inpatient costs by EUR 1778 (95% CI: 1694 to 1862, p < 0.001) compared to partial nephrectomy. Furthermore, radical nephrectomy had a higher risk of in-hospital transfusion (p < 0.001), sepsis (p < 0.001), acute respiratory failure (p < 0.001), acute kidney disease (p < 0.001), acute thromboembolism (p < 0.001), surgical wound infection (p < 0.001), ileus (p < 0.001), intensive care unit admission (p < 0.001), and pancreatitis (p < 0.001). Conclusions: More patients are offered partial nephrectomy in Germany. Patients undergoing radical nephrectomy present with a higher rate of concomitant risk factors and have increased perioperative morbidity and mortality, prolonged hospitalization, and increased in-hospital costs.

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“…Nowadays, RCCs are detected with decreasing size, leading to increased adoption of minimally invasive PN as the treatment of choice for T1 RCC 1 . However, local tumor ablation, 2–4 including RFA 5 and Cryo, 6 and active surveillance, 7 has gained popularity in elderly and comorbid patients due to a lower burden than surgery 8–10 . Nevertheless, a major limitation of studies comparing ablation with PN consists of selection bias that justifies higher all‐cause mortality in patients treated with ablative techniques, which are usually suggested for aged and fragile patients with higher comorbidities 11 .…”

Section: Introductionmentioning

confidence: 99%

Percutaneous ablation or minimally invasive partial nephrectomy for cT1a renal masses? A propensity score‐matched analysis

et al. 2021

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Objective Local tumor ablation to treat small renal mass is increasing. The aim of the present study was to compare oncologic outcomes among patients with T1 renal mass treated with partial nephrectomy and local tumor ablation. Methods To reduce the inherent differences between patients undergoing laparoscopic or robot‐assisted partial nephrectomy (n = 405) and local tumor ablation (n = 137), we used a 1:1 propensity score‐matched analysis. Local tumor ablation consisted of radiofrequency ablation and cryoablation. Disease‐free survival, overall survival and other causes mortality‐free survival rates were estimated using the Kaplan–Meier method. Multivariable logistic regression and competing‐risk regression models were used to identify predictors of complications, recurrence and other causes mortality, respectively. Results Partial nephrectomy had higher disease‐free survival estimates, as compared with local tumor ablation (92.8% vs 80.4% at 5 years, P = 0.02), with no significant difference between radiofrequency ablation and cryoablation (P = 0.9). Ablation showed comparable overall survival estimates to partial nephrectomy (91% vs 95.8% at 5 years, P = 0.6). The 5‐year recurrence rates were 7.9% versus 23.8% for patients aged ≤70 years, and 2.5% versus 11.9% for patients aged >70 years treated with partial nephrectomy and ablation, respectively; the 5‐year other causes mortality rates were 0% and 2.2% for patients treated with partial nephrectomy and ablation aged ≤70 years, and 3% versus 10.9% for patients aged >70 years treated with partial nephrectomy and ablation, respectively. At multivariable analysis, ablation was associated with fewer complications (odds ratio 0.41; P = 0.01). At competing risks analysis, age (hazard ratio 0.96) and ablation (hazard ratio 4.56) were independent predictors of disease recurrence (all P ≤ 0.008). Conclusions Local tumor ablation showed a higher risk of recurrence and lower risk of complications compared with partial nephrectomy, with comparable overall survival rates.

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Assessment of local tumor ablation and non-interventional management versus partial nephrectomy in T1a renal cell carcinoma

Cited by 17 publications

References 23 publications

Cancer-specific Mortality After Cryoablation vs Heat-based Thermal Ablation in T1a Renal Cell Carcinoma

Cancer-specific Mortality After Cryoablation vs Heat-based Thermal Ablation in T1a Renal Cell Carcinoma

Surgical Trends and Complications in Partial and Radical Nephrectomy: Results from the GRAND Study

Percutaneous ablation or minimally invasive partial nephrectomy for cT1a renal masses? A propensity score‐matched analysis

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