Long-term outcomes of image-guided ablation and laparoscopic partial nephrectomy for T1 renal cell carcinoma

Abstract

Objective To compare long-term outcomes and peri-operative outcomes of image-guided ablation (IGA) and laparoscopic partial nephrectomy (LPN). Material and methods This is a retrospective cohort study of localised RCC (T1a/bN0M0) patients undergoing cryoablation (CRYO), radio-frequency ablation (RFA), or LPN at our institution from 2003 to 2016. Oncological outcomes were compared using Cox regression and log-rank analysis. eGFR changes were compared using Kruskal-Wallis and Wilcoxon-rank tests. Results A total of 296 (238 T1a, 58 T1b) consecutive patients were identified; 103, 100, and 93 patients underwent CRYO, RFA, and LPN, respectively. Median follow-up time was 75, 98, and 71 months, respectively. On univariate analysis, all oncological outcomes were comparable amongst CRYO, RFA, and LPN (p > 0.05). On multivariate analysis, T1a patients undergoing RFA had improved local recurrence-free survival (LRFS) (HR 0.002, 95% CI 0.00–0.11, p = 0.003) and metastasis-free survival (HR 0.002, 95% CI 0.00–0.52, p = 0.029) compared to LPN. In T1a and T1b patients combined, both CRYO (HR 0.07, 95% CI 0.01–0.73, p = 0.026) and RFA (HR 0.04, 95% CI 0.03–0.48, p = 0.011) had improved LRFS rates. Patients undergoing CRYO and RFA had a significantly smaller median decrease in eGFR post-operatively compared to LPN (T1a: p < 0.001; T1b: p = 0.047). Limitations include retrospective design and limited statistical power. Conclusions IGA is potentially as good as LPN in oncological durability. IGA preserves kidney function significantly better than LPN. More studies with larger sample size should be performed to establish IGA as a first-line treatment alongside LPN. Key Points • Ablative therapies are alternatives to partial nephrectomy for managing small renal cell carcinomas. • This study reports long-term outcomes of image-guided ablation versus partial nephrectomy. • Ablative therapies have comparable oncological durability and better renal function preservation compared to partial nephrectomy.

The Role of Focal Therapy and Active Surveillance for Small Renal Mass Therapy

“…For cT1b, the results were: 77.78%, 92.68%, 93.8%, 93.7% for OS, RFS, DSS and MFS, respectively. Which, when compared to the work of Aron et al 2010 [ 49 ] with OS, RFS, DSS and MFS results of 84%, 87%, 89% and 89% for cT1a, presents results in favor of the more recent work [ 15 , 16 , 26 , 27 , 28 , 34 ], presented in our review.…”

“…Wośkowiak et al [ 48 ] pointed out that data on long term follow-up of CA and RFA are limited. We managed to find results [ 16 , 34 ] on 10 year survival with mean OS, RFS, DSS, MFS of 72.95%, 80.65%, 97%, 100%, respectively for CA and 5 year [ 26 , 27 , 34 ] for RFA with mean OS, RFS, DSS, MFS of 87.8%, 95.8%, 98.13% and 97.07%, respectively, which are superior to the OS, RFS, DSS and MFS results of 75.8%, 93.5%, 97.9% and 87.7% in a study [ 50 ] mentioned in an earlier review [ 48 ].…”

The Prognostic Value of Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio for Small Renal Cell Carcinomas after Image-Guided Cryoablation or Radio-Frequency Ablation

“…The MFS rates are 97.9% (95% CI 94.4–99.2%) at both five and ten years. Full oncological outcomes, in comparison to partial nephrectomy, have been reported previously [ 2 ].…”

“…A recent systematic review and meta-analysis comparing the ablative therapies and partial nephrectomy showed comparable oncological outcomes, superior renal function preservation and superior complication rates in ablation patients in comparison to partial nephrectomy patients [ 1 ]. Similarly, a retrospective study with 10 years of experience also showed comparable oncological outcomes and superior renal function in patients undergoing IGA compared to PN [ 2 ]. In specifically selected patients, active surveillance may be a viable option [ 3 ].…”

Percutaneous treatment of renal tumours

“…Published evidence has shown improving oncological outcomes in thermal ablation for the management of T1a renal tumours. There are now multiple long term singlecentre studies [6][7][8][9][10] and multiple larger population based studies [11][12][13] that support use of thermal ablation for the management of T1a tumours. Two prospective studies by Wah et al 8 in165 patients and Leveillee et al 7 in 274 patients show that RFA is clinically effective and safe with a low recurrence rate and high overall survival (OS) (Table 1).…”