Small renal masses: long-term data support percutaneous ablation

  • Eur Urol
  • 3 May 2019

  • curated by Deepa Koli
  • Univadis Clinical Summaries
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Takeaway

  • In patients with cT1 renal masses, local recurrence- and metastases-free survival and cancer-specific survival (LRFS, MFS, CSS, respectively) were not significantly different with percutaneous ablation vs partial nephrectomy (PN) in the long term.

Why this matters

  • Percutaneous ablation may be an acceptable option for patients not suitable for surgery.

Study design

  • Retrospective study of 1798 patients with primary cT1N0M0 renal masses (cT1a, n=1422; cT1b, n=376) who underwent PN, percutaneous radiofrequency ablation (RFA), and cryoablation during 2000-2011.
  • Funding: None.

Key results

  • Median follow-up time range: 6.0-9.4 years.
  • LRFS, MFS, and CSS did not differ among:
    • RFA vs PN in cT1a patients: HR, 1.49 (P=.4), 1.46 (P=.6), 1.99 (P=.5), respectively;
    • cryoablation vs PN in cT1a patients: HR, 1.88 (P=.18), 0.23 (P=.15), 0.29 (P=.4), respectively; or
    • cryoablation vs PN in cT1b patients: HR, 1.22 (P=.8), 0.95 (P>.9), 1.94 (P=.4), respectively.
  • 5-year CSS was 99.3%, 95.6%, and 100% for PN, RFA, and cryoablation, respectively, in cT1a patients, and 98% and 91% for PN and cryoablation in cT1b patients.
  • RFA and cryoablation were associated with worse OS vs PN in cT1a patients (HR, 1.81 and 2.03, respectively; both P<.001>
  • Cryoablation was associated with worse OS vs PN in cT1b patients (HR, 2.74; P<.001>

Limitations

  • Single-center study, selection bias.