Advertisement
×
Upcoming Site Maintenance on Tuesday, May 28, 2024: Please note that some site functionality such as new user registrations, updates to user accounts, and article purchases will be unavailable during maintenance on this date.
You are prohibited from using or uploading content you accessed through this website into external applications, bots, software, or websites, including those using artificial intelligence technologies and infrastructure, including deep learning, machine learning and large language models and generative AI.
No AccessJournal of UrologyAdult Urology1 Dec 2019

Cryoablation Predisposes to Higher Cancer Specific Mortality Relative to Partial Nephrectomy in Patients with Nonmetastatic pT1b Kidney Cancer

View All Author Information

Purpose:

Cryoablation is done in select patients with pT1b nonmetastatic renal cell carcinoma without convincing proof of efficacy. Our aim was to test for differences in the cancer specific mortality rate for cryoablation and partial nephrectomy in T1b nonmetastatic renal cell carcinoma cases.

Materials and Methods:

In the 2004 to 2015 SEER (Surveillance, Epidemiology, and End Results) database we identified 5,763 patients with a T1b tumor treated with cryoablation or partial nephrectomy. Modeling relied on multivariable logistic regression models predicting cryoablation vs partial nephrectomy. After 1:2 ratio propensity score matching between patients treated with cryoablation vs partial nephrectomy we used cumulative incidence plot and competing risks regression to test differences in cancer specific mortality and other cause mortality rates.

Results:

Relative to the 5,521 patients who underwent partial nephrectomy the 242 treated with cryoablation were older, had smaller tumors and more frequently harbored unclassified renal cell carcinoma of low or unknown grade. Median followup was 38 months. In multivariable logistic regression models predicting cryoablation vs partial nephrectomy more advanced patient age was an independent predictor (OR 1.03; p=0.007). After propensity score matching and other cause mortality adjustment the 5-year cancer specific mortality rate was 2.5-fold higher after cryoablation than after partial nephrectomy (p=0.03). Conversely after propensity score matching and cancer specific mortality adjustment the 5-year other cause mortality rate was similar to that of partial nephrectomy after cryoablation (HR 1.45, p=0.12). The major limitation of this study was the lack of recurrence and metastatic progression data.

Conclusions:

The current findings demonstrated a 2.5-fold increase in cancer specific mortality when cryoablation was performed in patients with pT1b renal cell carcinoma. This observation should be interpreted as a contraindication to cryoablation outside clinical trials or institutional protocols.

References

  • 1. : Cryoablation versus partial nephrectomy for clinical T1b renal tumors: a matched group comparative analysis. Eur Urol 2017; 71: 111. Google Scholar
  • 2. : Comparison of partial nephrectomy and percutaneous ablation for cT1 renal masses. Eur Urol 2015; 67: 252. Google Scholar
  • 3. : Radiofrequency ablation versus cryoablation for T1b renal cell carcinoma: a multi-center study. Jpn J Radiol 2018; 36: 551. Google Scholar
  • 4. : Safety considerations and local tumor control following percutaneous image-guided cryoablation of T1b renal tumors. Cardiovasc Intervent Radiol 2018; 41: 449. Google Scholar
  • 5. : Percutaneous cryoablation of stage T1b renal cell carcinoma: technique considerations, safety, and local tumor control. J Vasc Interv Radiol 2015; 26: 792. Google Scholar
  • 6. : Laparoscopic radiofrequency ablation with intraoperative contrast-enhanced ultrasonography for T1bN0M0 renal tumors: initial functional and oncologic outcomes. J Endourol 2014; 28: 4. Google Scholar
  • 7. : Long-term oncologic outcomes after radiofrequency ablation for T1 renal cell carcinoma. Eur Urol 2013; 63: 486. Google Scholar
  • 8. : Radiofrequency ablation versus radical nephrectomy: clinical outcomes for stage T1b renal cell carcinoma. Radiology 2014; 270: 292. Google Scholar
  • 9. : Radio frequency ablation versus partial nephrectomy for clinical T1b renal cell carcinoma: long-term clinical and oncologic outcomes. J Urol 2015; 193: 430. LinkGoogle Scholar
  • 10. : Renal mass and localized renal cancer: AUA guideline. J Urol 2017; 198: 520. LinkGoogle Scholar
  • 11. : EAU Guidelines on Renal Cell Carcinoma. European Association of Urology 2018. Available at http://uroweb.org/wp-content/uploads/EAU-RCC-Guidelines-2018-large-text.pdf. Accessed November 23, 2018. Google Scholar
  • 12. National Cancer Institute Surveillance, Epidemiology and End Results Program: Overview of the SEER Program. Available at https://seer.cancer.gov/about/overview.html. Accessed January 24, 2019. Google Scholar
  • 13. : An introduction to propensity score methods for reducing the effects of confounding in observational studies. Multivariate Behav Res 2011; 46: 399. Google Scholar
  • 14. : Introduction to the analysis of survival data in the presence of competing risks. Circulation 2016; 133: 601. Google Scholar
  • 15. : Thermal ablation vs surgery for localized kidney cancer: a Surveillance, Epidemiology, and End results (SEER) database analysis. Urology 2011; 78: 93. Google Scholar
  • 16. : Cryoablation or radiofrequency ablation of the small renal mass. Cancer 2008; 113: 2671. Google Scholar
  • 17. : Cryoablation vs radiofrequency ablation for the treatment of renal cell carcinoma: a meta-analysis of case series studies. BJU Int 2012; 110: 510. Google Scholar
  • 18. : Local tumor destruction in renal cell carcinoma—an inpatient population-based study. Urol Oncol Semin Orig Investig 2014; 32: 54.e1. Google Scholar
  • 19. : Evaluation of the charges, safety, and mortality of percutaneous renal thermal ablation using the Nationwide Inpatient Sample. J Vasc Interv Radiol 2015; 26: 342. Google Scholar
  • 20. : Local tumour ablation for localized kidney cancer: practice patterns in Canada. Can Urol Assoc J 2015; 9: 420. Google Scholar

The corresponding author certifies that, when applicable, a statement(s) has been included in the manuscript documenting institutional review board, ethics committee or ethical review board study approval; principles of Helsinki Declaration were followed in lieu of formal ethics committee approval; institutional animal care and use committee approval; all human subjects provided written informed consent with guarantees of confidentiality; IRB approved protocol number; animal approved project number.

No direct or indirect commercial, personal, academic, political, religious or ethical incentive is associated with publishing this article.

Advertisement