Among patients with T1a renal cell carcinoma (RCC), those who undergo local tumor destruction (LTD), such as ablation, rather than partial nephrectomy (PN) have higher risks of early death, a new study finds.
Using the 2004-2018 Surveillance, Epidemiology, and End Results (SEER) database, investigators identified 42,920 patients with histologically confirmed T1a RCC, of whom 35,984 underwent PN and 5936 underwent LTD (ie, cryoablation or heat-based thermal ablation). They propensity score matched 5352 patients in the PN group and 5352 patients in the LTD group by RCC histological subtype, tumor size, tumor grade, and age.
The 10-year cancer-specific mortality rate was higher in the LTD group: 8.7% vs 5.5% for PN. In multivariable competing risks regression models, the LTD group with T1a RCC had a significant 58% increased risk of cancer-specific death compared with the PN group, Gabriele Sorce, MD, of Urological Research Institute, IRCCS San Raffaele Scientific Institute in Milan, Italy, and colleagues reported in European Urology Focus.
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According to tumor size, the risk for cancer-specific mortality was significantly increased 1.5-fold in patients with a tumor size of 3 cm or less and 1.7-fold in patients with tumor size 3.1-4 cm.
“Taken together, these observations indicate a clear [cancer-specific mortality] disadvantage for LTD versus PN. This disadvantage is accentuated with increasing tumor size,” according to Dr Sorce’s team.
Among the study’s limitations, the SEER database lacked information on the number of kidney tumors, tumor site, surgery type (open, laparoscopic, or robotic-assisted PN, and percutaneous or laparoscopic LTD), and retreatment rates.
The investigators reported that the 10-year other-cause mortality rate was significantly higher for LTD group after propensity-score matching: 31.2% vs 22.2% PN. In the overall cohort, LTD patients were older and more frequently harbored RCC of unknown histological subtype or grade.
Dr Sorce’s team pointed out that LTD is still a valid option when renal function preservation or surgical contraindications outweigh the cancer control disadvantage.
Reference
Sorce G, Hoeh B, Hohenhorst L, et al. Cancer-specific mortality in T1a renal cell carcinoma treated with local tumor destruction versus partial nephrectomy. Eur Urol Focus. Published online July 30, 2022. doi:10.1016/j.euf.2022.07.005
