Abstract:
BACKGROUND:Partial nephrectomy (PN) is a preferred treatment for cT1 renal masses, whereas thermal ablation represents an alternative nephron-sparing option, albeit with higher reported rates of recurrence. OBJECTIVE:To review our experience with PN, percutaneous radiofrequency ablation (RFA), and percutaneous cryoablation for cT1 renal masses. DESIGN, SETTING, AND PARTICIPANTS:A total of 1803 patients with primary cT1N0M0 renal masses treated between 2000 and 2011 were identified from the prospectively maintained Mayo Clinic Renal Tumor Registry. INTERVENTION:PN compared with percutaneous ablation. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS:Local recurrence-free, metastases-free, and overall survival rates were estimated using the Kaplan-Meier method and compared with log-rank tests. RESULTS AND LIMITATIONS:Of the 1424 cT1a patients, 1057 underwent PN, 180 underwent RFA, and 187 underwent cryoablation. In this cohort, local recurrence-free survival was similar among the three treatments (p=0.49), whereas metastases-free survival was significantly better after PN (p=0.005) and cryoablation (p=0.021) when compared with RFA. Of the 379 cT1b patients, 326 patients underwent PN, and 53 patients were managed with cryoablation (8 RFA patients were excluded). In this cohort, local recurrence-free survival (p=0.81) and metastases-free survival (p=0.45) were similar between PN and cryoablation. In both the cT1a and cT1b groups, PN patients were significantly younger, with lower Charlson scores and had superior overall survival (p<0.001 for all). Limitations include retrospective review and selection bias. CONCLUSIONS:In a large cohort of sporadic cT1 renal masses, we observed that recurrence-free survival was similar for PN and percutaneous ablation patients. Metastases-free survival was superior for PN and cryoablation patients when compared with RFA for cT1a patients. Overall survival was superior after PN, likely because of selection bias. If these results were validated, an update to clinical guidelines would be warranted. PATIENT SUMMARY:Partial nephrectomy and percutaneous ablation for small (<7-cm) and localized renal masses are associated with similar rates of local recurrence.
journal_name
Eur Uroljournal_title
European urologyauthors
Thompson RH,Atwell T,Schmit G,Lohse CM,Kurup AN,Weisbrod A,Psutka SP,Stewart SB,Callstrom MR,Cheville JC,Boorjian SA,Leibovich BCdoi
10.1016/j.eururo.2014.07.021subject
Has Abstractpub_date
2015-02-01 00:00:00pages
252-9issue
2eissn
0302-2838issn
1873-7560pii
S0302-2838(14)00673-3journal_volume
67pub_type
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