sABLATE: a simplified ABLATE score for prediction of complications and outcome in percutaneous thermal ablation of renal lesions

Abstract

To evaluate the performance of a simplified-ABLATE score (sABLATE) in predicting complications and outcome in respect to RENAL, mRENAL and ABLATE scores. MethodsThis study included 136 renal lesions in 113 patients (M:F ratio=2.5; mean age 70.8 years). 98 tumors underwent cryoablation at San Raffaele hospital between 01/2015 and 03/2020, 37 microwave ablation at San Paolo or Policlinico hospitals between 07/2016 and 03/2020. RENAL, mRENAL, ABLATE and sABLATE scores were calculated using preprocedural imaging. Data regarding complications and follow-up were registered. Mann-Whitney U test, ROC analyses, and logistic regression analyses were used for complications. Cox-regression analyses were performed for outcome ResultsMean tumor diameter was 23.2mm. Mean and median RENAL, mRENAL, ABLATE and sABLATE scores were 6.8 and 7, 6.9 and 7, 5.3 and 5, and 3.5 and 3, respectively. During a mean follow-up of 21.9 months (range 1-73) we registered 7 complications, 3 cases of residual disease and 10 local tumor progressions. Mann-Whitney U test pvalues for complications for RENAL, mRENAL, ABLATE and sABLATE were 0.51, 0.49, 0.66 and 0.056 respectively. ROC analyses for complications showed an AUC for RENAL, mRENAL, ABLATE and sABLATE of 0.57, 0.57, 0.55 and 0.71 respectively. Regarding outcome, HR and p-values of Cox-regression analyses were 1.30 and 0.36 for RENAL, 1.33 and 0.35 for mRENAL, 2.16 and 0.01 for ABLATE, 2.29 and 0.004 for sABLATE. ConclusionsABLATE was the only score close to significance for complications, representing a progress even if not definitive.Regarding outcome, ABLATE confirmed its value, and sABLATE maintained validity despite being a simplification.

Ultrasound-Guided Percutaneous Thermal Ablation of Renal Cancers—In Search for the Ideal Tumour

“…In recent years, thermal ablation has been gaining popularity, and is now accepted as one of the treatment methods in SRMs, including successful treatment of obese patients and cystic lesions [3,[20][21][22][23]. Some authors reported comparable results of thermal ablation and NSS in selected patients [9,20,24].…”

“…In recent years, the progress in imaging techniques and wide introduction of ultrasonography (US) and computed tomography (CT) imaging has led to an increased detection of renal tumours, including small renal masses (SRM, kidney tumours smaller than 4 cm) [1,2]. While surgery is still the standard of care, there is a growing interest in Cancers 2023, 15, 518 2 of 10 minimally invasive treatment, such as thermal ablation [3]. The efficacy of thermal ablation has already been demonstrated, especially in case of SRMs, it is preferred for patients with renal masses ≤3 cm with contraindications or unwillingness to undergo surgery, especially people who are elderly, or have comorbidity, with bilateral tumours, and solitary kidney [4][5][6][7].…”

“…US-guided percutaneous ablation is particularly attractive because it is a relatively simple procedure and it can be performed by urologists skilled in US-guided techniques [2,10]. While thermal ablation and NSS have comparable rates of metastatic-free and disease-free survival, ablation has higher rates of local recurrence [2,3,[10][11][12][13].…”

“…Over the years, several nephrometry scores, such as RENAL and PADUA, were developed in order to predict the risk of relapse and complications after treatment of renal tumours [3,[14][15][16]. The RENAL score was also evaluated in patients undergoing renal tumour ablation [17].…”

“…The RENAL score was also evaluated in patients undergoing renal tumour ablation [17]. However, both RENAL and its modification, mRENAL, were developed for surgical resections and its usefulness in context of percutaneous ablations remain controversial, as challenges of percutaneous ablation are different from those of surgery [3,14,18]. Recently, new scores-ABLATE and sABLATE-were developed by interventional radiologists with promising initial results [3,14].…”