Oncologic Outcomes Following Partial Nephrectomy and Percutaneous Ablation for cT1 Renal Masses

Jack R. Andrews, Thomas Atwell, Grant Schmit, Christine M. Lohse, A. Nicholas Kurup, Adam Weisbrod, Matthew R Callstrom, John Cheville, Stephen A. Boorjian, Bradley Leibovich, R. Houston Thompson

Research output: Contribution to journalArticle

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Abstract

Background: Long-term data comparing partial nephrectomy (PN) and thermal ablation are lacking. Objective: To update our experience with PN, percutaneous radiofrequency ablation (RFA), and percutaneous cryoablation for cT1 renal masses. Design, setting, and participants: A total of 1798 patients with primary cT1N0M0 renal masses treated between 2000 and 2011 at Mayo Clinic were identified. Intervention: Percutaneous ablation versus PN. Outcome measurements and statistical analysis: Cancer-specific survival (CSS) was estimated using the Kaplan-Meier method. Local recurrence, metastases, and death from renal cell carcinoma (RCC) were compared with propensity-score–adjusted Cox models. Results and limitations: Among 1422 cT1a patients, 1055, 180, and 187 underwent PN, RFA, and cryoablation with median clinical follow-up of 9.4, 7.5, and 6.3 yr, respectively. Comparisons of RFA with PN resulted in hazard ratios (HRs) of 1.49 (95% confidence interval [CI] 0.55–4.04, p = 0.4), 1.46 (95% CI 0.41–5.19, p = 0.6), and 1.99 (95% CI 0.29–13.56, p = 0.5) for local recurrence, metastases, and death from RCC. Comparisons of cryoablation to PN resulted in HRs of 1.88 (95% CI 0.76–4.66, p = 0.18), 0.23 (95% CI 0.03–1.72, p = 0.15), and 0.29 (95% CI 0.01–6.11, p = 0.4) for these same outcomes. Five-year CSS was 99%, 96%, and 100% for PN, RFA, and cryoablation, respectively. Among 376 cT1b patients, 324 and 52 underwent PN and cryoablation with median clinical follow-up of 8.7 and 6.0 yr, respectively. Comparisons of cryoablation with PN resulted in HRs of 1.22 (95% CI 0.33–4.48, p = 0.8), 0.95 (95% CI 0.21–4.38, p > 0.9), and 1.94 (95% CI 0.42–8.96, p = 0.4) for local recurrence, metastases, and death from RCC, respectively. Five-year CSS was 98% and 91% for PN and cryoablation, respectively. Limitations include retrospective review and selection bias. Conclusions: With mature follow-up at a single institution, percutaneous ablation appears to have acceptable results for cT1 renal tumors and is appropriate for patients with a contraindication for surgery. For cT1a patients, clinically relevant differences between PN and ablation are unlikely, and treatment choice should involve shared decision making. For cT1b patients, death from RCC was more common with cryoablation, and large differences in this outcome cannot be ruled out. Further research is needed to confirm the oncologic effectiveness of cryoablation in the cT1b setting. Patient summary: With appropriate patient triage, partial nephrectomy and percutaneous ablation can be used to treat cT1 renal masses, although additional follow-up and further study are still needed. Percutaneous ablation appears to have acceptable results for cT1 renal tumors. With appropriate patient triage, partial nephrectomy and percutaneous ablation can be used to treat cT1 renal masses, although additional follow-up and further study are still needed.

Original languageEnglish (US)
JournalEuropean urology
DOIs
StatePublished - Jan 1 2019

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Nephrectomy
Cryosurgery
Kidney
Confidence Intervals
Renal Cell Carcinoma
Triage
Neoplasms
Neoplasm Metastasis
Recurrence
Survival
Selection Bias
Proportional Hazards Models
Decision Making
Hot Temperature

Keywords

  • Ablation techniques
  • Cryosurgery
  • Kidney neoplasms
  • Partial nephrectomy
  • Thermal ablation

ASJC Scopus subject areas

  • Urology

Cite this

Andrews, J. R., Atwell, T., Schmit, G., Lohse, C. M., Kurup, A. N., Weisbrod, A., ... Thompson, R. H. (2019). Oncologic Outcomes Following Partial Nephrectomy and Percutaneous Ablation for cT1 Renal Masses. European urology. https://doi.org/10.1016/j.eururo.2019.04.026

Oncologic Outcomes Following Partial Nephrectomy and Percutaneous Ablation for cT1 Renal Masses. / Andrews, Jack R.; Atwell, Thomas; Schmit, Grant; Lohse, Christine M.; Kurup, A. Nicholas; Weisbrod, Adam; Callstrom, Matthew R; Cheville, John; Boorjian, Stephen A.; Leibovich, Bradley; Thompson, R. Houston.

In: European urology, 01.01.2019.

Research output: Contribution to journalArticle

Andrews, JR, Atwell, T, Schmit, G, Lohse, CM, Kurup, AN, Weisbrod, A, Callstrom, MR, Cheville, J, Boorjian, SA, Leibovich, B & Thompson, RH 2019, 'Oncologic Outcomes Following Partial Nephrectomy and Percutaneous Ablation for cT1 Renal Masses', European urology. https://doi.org/10.1016/j.eururo.2019.04.026
Andrews, Jack R. ; Atwell, Thomas ; Schmit, Grant ; Lohse, Christine M. ; Kurup, A. Nicholas ; Weisbrod, Adam ; Callstrom, Matthew R ; Cheville, John ; Boorjian, Stephen A. ; Leibovich, Bradley ; Thompson, R. Houston. / Oncologic Outcomes Following Partial Nephrectomy and Percutaneous Ablation for cT1 Renal Masses. In: European urology. 2019.
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title = "Oncologic Outcomes Following Partial Nephrectomy and Percutaneous Ablation for cT1 Renal Masses",
abstract = "Background: Long-term data comparing partial nephrectomy (PN) and thermal ablation are lacking. Objective: To update our experience with PN, percutaneous radiofrequency ablation (RFA), and percutaneous cryoablation for cT1 renal masses. Design, setting, and participants: A total of 1798 patients with primary cT1N0M0 renal masses treated between 2000 and 2011 at Mayo Clinic were identified. Intervention: Percutaneous ablation versus PN. Outcome measurements and statistical analysis: Cancer-specific survival (CSS) was estimated using the Kaplan-Meier method. Local recurrence, metastases, and death from renal cell carcinoma (RCC) were compared with propensity-score–adjusted Cox models. Results and limitations: Among 1422 cT1a patients, 1055, 180, and 187 underwent PN, RFA, and cryoablation with median clinical follow-up of 9.4, 7.5, and 6.3 yr, respectively. Comparisons of RFA with PN resulted in hazard ratios (HRs) of 1.49 (95{\%} confidence interval [CI] 0.55–4.04, p = 0.4), 1.46 (95{\%} CI 0.41–5.19, p = 0.6), and 1.99 (95{\%} CI 0.29–13.56, p = 0.5) for local recurrence, metastases, and death from RCC. Comparisons of cryoablation to PN resulted in HRs of 1.88 (95{\%} CI 0.76–4.66, p = 0.18), 0.23 (95{\%} CI 0.03–1.72, p = 0.15), and 0.29 (95{\%} CI 0.01–6.11, p = 0.4) for these same outcomes. Five-year CSS was 99{\%}, 96{\%}, and 100{\%} for PN, RFA, and cryoablation, respectively. Among 376 cT1b patients, 324 and 52 underwent PN and cryoablation with median clinical follow-up of 8.7 and 6.0 yr, respectively. Comparisons of cryoablation with PN resulted in HRs of 1.22 (95{\%} CI 0.33–4.48, p = 0.8), 0.95 (95{\%} CI 0.21–4.38, p > 0.9), and 1.94 (95{\%} CI 0.42–8.96, p = 0.4) for local recurrence, metastases, and death from RCC, respectively. Five-year CSS was 98{\%} and 91{\%} for PN and cryoablation, respectively. Limitations include retrospective review and selection bias. Conclusions: With mature follow-up at a single institution, percutaneous ablation appears to have acceptable results for cT1 renal tumors and is appropriate for patients with a contraindication for surgery. For cT1a patients, clinically relevant differences between PN and ablation are unlikely, and treatment choice should involve shared decision making. For cT1b patients, death from RCC was more common with cryoablation, and large differences in this outcome cannot be ruled out. Further research is needed to confirm the oncologic effectiveness of cryoablation in the cT1b setting. Patient summary: With appropriate patient triage, partial nephrectomy and percutaneous ablation can be used to treat cT1 renal masses, although additional follow-up and further study are still needed. Percutaneous ablation appears to have acceptable results for cT1 renal tumors. With appropriate patient triage, partial nephrectomy and percutaneous ablation can be used to treat cT1 renal masses, although additional follow-up and further study are still needed.",
keywords = "Ablation techniques, Cryosurgery, Kidney neoplasms, Partial nephrectomy, Thermal ablation",
author = "Andrews, {Jack R.} and Thomas Atwell and Grant Schmit and Lohse, {Christine M.} and Kurup, {A. Nicholas} and Adam Weisbrod and Callstrom, {Matthew R} and John Cheville and Boorjian, {Stephen A.} and Bradley Leibovich and Thompson, {R. Houston}",
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day = "1",
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language = "English (US)",
journal = "European Urology",
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TY - JOUR

T1 - Oncologic Outcomes Following Partial Nephrectomy and Percutaneous Ablation for cT1 Renal Masses

AU - Andrews, Jack R.

AU - Atwell, Thomas

AU - Schmit, Grant

AU - Lohse, Christine M.

AU - Kurup, A. Nicholas

AU - Weisbrod, Adam

AU - Callstrom, Matthew R

AU - Cheville, John

AU - Boorjian, Stephen A.

AU - Leibovich, Bradley

AU - Thompson, R. Houston

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Long-term data comparing partial nephrectomy (PN) and thermal ablation are lacking. Objective: To update our experience with PN, percutaneous radiofrequency ablation (RFA), and percutaneous cryoablation for cT1 renal masses. Design, setting, and participants: A total of 1798 patients with primary cT1N0M0 renal masses treated between 2000 and 2011 at Mayo Clinic were identified. Intervention: Percutaneous ablation versus PN. Outcome measurements and statistical analysis: Cancer-specific survival (CSS) was estimated using the Kaplan-Meier method. Local recurrence, metastases, and death from renal cell carcinoma (RCC) were compared with propensity-score–adjusted Cox models. Results and limitations: Among 1422 cT1a patients, 1055, 180, and 187 underwent PN, RFA, and cryoablation with median clinical follow-up of 9.4, 7.5, and 6.3 yr, respectively. Comparisons of RFA with PN resulted in hazard ratios (HRs) of 1.49 (95% confidence interval [CI] 0.55–4.04, p = 0.4), 1.46 (95% CI 0.41–5.19, p = 0.6), and 1.99 (95% CI 0.29–13.56, p = 0.5) for local recurrence, metastases, and death from RCC. Comparisons of cryoablation to PN resulted in HRs of 1.88 (95% CI 0.76–4.66, p = 0.18), 0.23 (95% CI 0.03–1.72, p = 0.15), and 0.29 (95% CI 0.01–6.11, p = 0.4) for these same outcomes. Five-year CSS was 99%, 96%, and 100% for PN, RFA, and cryoablation, respectively. Among 376 cT1b patients, 324 and 52 underwent PN and cryoablation with median clinical follow-up of 8.7 and 6.0 yr, respectively. Comparisons of cryoablation with PN resulted in HRs of 1.22 (95% CI 0.33–4.48, p = 0.8), 0.95 (95% CI 0.21–4.38, p > 0.9), and 1.94 (95% CI 0.42–8.96, p = 0.4) for local recurrence, metastases, and death from RCC, respectively. Five-year CSS was 98% and 91% for PN and cryoablation, respectively. Limitations include retrospective review and selection bias. Conclusions: With mature follow-up at a single institution, percutaneous ablation appears to have acceptable results for cT1 renal tumors and is appropriate for patients with a contraindication for surgery. For cT1a patients, clinically relevant differences between PN and ablation are unlikely, and treatment choice should involve shared decision making. For cT1b patients, death from RCC was more common with cryoablation, and large differences in this outcome cannot be ruled out. Further research is needed to confirm the oncologic effectiveness of cryoablation in the cT1b setting. Patient summary: With appropriate patient triage, partial nephrectomy and percutaneous ablation can be used to treat cT1 renal masses, although additional follow-up and further study are still needed. Percutaneous ablation appears to have acceptable results for cT1 renal tumors. With appropriate patient triage, partial nephrectomy and percutaneous ablation can be used to treat cT1 renal masses, although additional follow-up and further study are still needed.

AB - Background: Long-term data comparing partial nephrectomy (PN) and thermal ablation are lacking. Objective: To update our experience with PN, percutaneous radiofrequency ablation (RFA), and percutaneous cryoablation for cT1 renal masses. Design, setting, and participants: A total of 1798 patients with primary cT1N0M0 renal masses treated between 2000 and 2011 at Mayo Clinic were identified. Intervention: Percutaneous ablation versus PN. Outcome measurements and statistical analysis: Cancer-specific survival (CSS) was estimated using the Kaplan-Meier method. Local recurrence, metastases, and death from renal cell carcinoma (RCC) were compared with propensity-score–adjusted Cox models. Results and limitations: Among 1422 cT1a patients, 1055, 180, and 187 underwent PN, RFA, and cryoablation with median clinical follow-up of 9.4, 7.5, and 6.3 yr, respectively. Comparisons of RFA with PN resulted in hazard ratios (HRs) of 1.49 (95% confidence interval [CI] 0.55–4.04, p = 0.4), 1.46 (95% CI 0.41–5.19, p = 0.6), and 1.99 (95% CI 0.29–13.56, p = 0.5) for local recurrence, metastases, and death from RCC. Comparisons of cryoablation to PN resulted in HRs of 1.88 (95% CI 0.76–4.66, p = 0.18), 0.23 (95% CI 0.03–1.72, p = 0.15), and 0.29 (95% CI 0.01–6.11, p = 0.4) for these same outcomes. Five-year CSS was 99%, 96%, and 100% for PN, RFA, and cryoablation, respectively. Among 376 cT1b patients, 324 and 52 underwent PN and cryoablation with median clinical follow-up of 8.7 and 6.0 yr, respectively. Comparisons of cryoablation with PN resulted in HRs of 1.22 (95% CI 0.33–4.48, p = 0.8), 0.95 (95% CI 0.21–4.38, p > 0.9), and 1.94 (95% CI 0.42–8.96, p = 0.4) for local recurrence, metastases, and death from RCC, respectively. Five-year CSS was 98% and 91% for PN and cryoablation, respectively. Limitations include retrospective review and selection bias. Conclusions: With mature follow-up at a single institution, percutaneous ablation appears to have acceptable results for cT1 renal tumors and is appropriate for patients with a contraindication for surgery. For cT1a patients, clinically relevant differences between PN and ablation are unlikely, and treatment choice should involve shared decision making. For cT1b patients, death from RCC was more common with cryoablation, and large differences in this outcome cannot be ruled out. Further research is needed to confirm the oncologic effectiveness of cryoablation in the cT1b setting. Patient summary: With appropriate patient triage, partial nephrectomy and percutaneous ablation can be used to treat cT1 renal masses, although additional follow-up and further study are still needed. Percutaneous ablation appears to have acceptable results for cT1 renal tumors. With appropriate patient triage, partial nephrectomy and percutaneous ablation can be used to treat cT1 renal masses, although additional follow-up and further study are still needed.

KW - Ablation techniques

KW - Cryosurgery

KW - Kidney neoplasms

KW - Partial nephrectomy

KW - Thermal ablation

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