ORIGINAL ARTICLE   Free access

Minerva Urologica e Nefrologica 2020 June;72(3):350-9

DOI: 10.23736/S0393-2249.19.03496-9

Copyright © 2019 EDIZIONI MINERVA MEDICA

language: English

Assessment of local tumor ablation and non-interventional management versus partial nephrectomy in T1a renal cell carcinoma

Carlotta PALUMBO ^{1, 2} ✉, Francesco A. MISTRETTA ^{1, 3}, Sophie KNIPPER ^{1, 4}, Elio MAZZONE ^{1, 5}, Angela PECORARO ^{1, 6}, Zhe TIAN ¹, Paul PERROTTE ⁷, Alessandro ANTONELLI ², Francesco MONTORSI ⁵, Shahrokh F. SHARIAT ^{8, 9, 10, 11, 12}, Fred SAAD ^{1, 6}, Claudio SIMEONE ², Alberto BRIGANTI ⁵, Luke T. LAVALLEE ¹³, Pierre I. KARAKIEWICZ ^{1, 6}

¹ Unit of Cancer Prognostics and Health Outcomes, University of Montreal Health Center, Montreal, QB, Canada; ² Unit of Urology, Department of Medical and Surgical Specialties, Radiological Science and Public Health, ASST Spedali Civili of Brescia, University of Brescia, Brescia, Italy; ³ Department of Urology, European Institute of Oncology, Milan, Italy; ⁴ Martini Klinik, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; ⁵ Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy; ⁶ Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy; ⁷ Division of Urology, University of Montreal Hospital Center (CHUM), Montreal, QB, Canada; ⁸ Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; ⁹ Department of Urology, Weill Cornell Medical College, New York, NY, USA; ¹⁰ Department of Urology, University of Texas Southwestern, Dallas, TX, USA; ¹¹ Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic; ¹² Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia; ¹³ Division of Urology, The Ottawa Hospital, University of Ottawa and the Ottawa Hospital Research Institute, Ottawa, ON, Canada

BACKGROUND: Local tumor ablation (LTA) and non-interventional management (NIM) emerged as alternative management options for T1a renal cell carcinoma (RCC). We investigated trends and cancer-specific mortality (CSM) after LTA and NIM, compared to partial nephrectomy (PN).
METHODS: Within the Surveillance, Epidemiology, and End Results database (2004-2015), T1a RCC patients treated with PN, LTA or NIM were identified. Estimated annual proportion change methodology (EAPC), 1:1 ratio propensity score (PS) matching, cumulative incidence plots and multivariable competing risks regression models (CRR) were used to compare LTA vs. PN and NIM vs. PN. Subgroup analyses focused on patients <65 and ≥65 years.
RESULTS: Overall 4524 patients underwent LTA vs. 1654 NIM vs. 25,435 PN. Annuals rates increased for NIM (EAPC: +3.3%, P<0.001), but not for either LTA or PN. After PS-matching in multivariable CCR, LTA (HR 1.9, P<0.001) and NIM (HR 3.0, P<0.001) showed worse 5-year CSM, relative to PN. In subgroup analyses, LTA showed no CSM disadvantage relative to PN in younger patients (HR 2.0, P=0.07). In older patients 1.64-fold CSM increase was recorded. Conversely, NIM younger (HR 3.1, P=0.001) and older (HR 3.1, P<0.001) patients exhibited higher CSM relative to PN.
CONCLUSIONS: In T1a RCC patients, NIM rates showed a modest but significant increase, while LTA and PN rates remained stable. In survival analyses, LTA exhibited higher CSM rates only for elderly patients. Conversely, NIM exhibited higher CSM rates in both younger and older patients.

KEY WORDS: Carcinoma, Renal Cell; Nephrectomy; Ablation techniques; Observation