Outcomes After Cryoablation Versus Partial Nephrectomy for Sporadic Renal Tumors in a Solitary Kidney: A Propensity Score Analysis

Bimal Bhindi, Ross J. Mason, Mustafa M. Haddad, Stephen A. Boorjian, Bradley C. Leibovich, Thomas D. Atwell, Adam J. Weisbrod, Grant D. Schmit, R. Houston Thompson

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Abstract

Background: While partial nephrectomy (PN) is considered the standard approach for a tumor in a solitary kidney, percutaneous cryoablation (PCA) is emerging as an alternative nephron-sparing option. Objective: To compare outcomes between PCA and PN for tumors in a solitary kidney. Design, setting, and participants: Patients who underwent PCA or PN between 2005 and 2015 for a single primary renal tumor in a solitary kidney were identified using Mayo Clinic Registries. Exclusion criteria were inherited tumor syndromes and salvage procedures. Intervention: PCA and PN. Outcome measurements and statistical analysis: To achieve balance in baseline characteristics, we used inverse probability of treatment weighting (IPTW) based on propensity to receive treatment. The risk of having a post-treatment complication and percent drop in estimated glomerular filtration rate (eGFR), as well as the risks of local/ipsilateral recurrence, distant metastasis, and cancer-specific mortality, were compared between groups using logistic, linear, and Fine-and-Gray competing risk regression models. Results and limitations: The cohort included 118 patients (PCA: 54; PN: 64) with a median follow-up of 47 mo (interquartile range 18, 74). In unadjusted analyses, PCA was associated with a lower risk of complications (15% vs 31%; odds ratio [OR] = 0.38; 95% confidence interval [CI] 0.15, 0.96; p = 0.04). However, upon accounting for baseline differences with IPTW adjustment, there was no longer a significant difference in the risk of complications (28% vs 29%; OR = 0.95; 95% CI 0.53, 1.69; p = 0.9). There were no significant differences between PCA and PN in percentage drop in eGFR at discharge (mean: 11% vs 16%; β = -5%; 95% CI -13, 3; p = 0.2) or at 3 mo (12% vs 9%; β = 3%; 95% CI -3, 10; p = 0.3). Likewise, no significant differences were noted in local recurrence (HR = 0.87; 95% CI 0.38, 1.98; p = 0.7), distant metastases (HR = 0.60; 95% CI 0.30, 1.20; p = 0.2), or cancer-specific mortality (HR = 1.13; 95% CI 0.32, 3.98; p = 0.8). Limitations include the sample size, given the relative rarity of renal masses in solitary kidneys. Conclusions: Our study found no significant difference in complications, renal function outcomes, and oncologic outcomes between PN and PCA for patients with a tumor in a solitary kidney. Validation in a larger multi-institutional analysis may be warranted. Patient summary: Partial nephrectomy (surgery) and percutaneous cryoablation are both options for treating a kidney tumor while preserving the normal portion of the kidney. In patients with a tumor in their only kidney, we found no difference in the risk of complications, kidney function outcomes, or cancer control outcomes between these two approaches. Among patients with a sporadic renal tumor in a solitary kidney, there were no significant differences in complication risk, renal function outcomes, or oncologic outcomes between percutaneous cryoablation and partial nephrectomy.

Original languageEnglish (US)
JournalEuropean Urology
DOIs
StateAccepted/In press - 2017

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Keywords

  • Cryosurgery
  • Kidney neoplasms
  • Partial nephrectomy
  • Percutaneous cryoablation
  • Renal cell carcinoma

ASJC Scopus subject areas

  • Urology

Cite this

Bhindi, B., Mason, R. J., Haddad, M. M., Boorjian, S. A., Leibovich, B. C., Atwell, T. D., Weisbrod, A. J., Schmit, G. D., & Thompson, R. H. (Accepted/In press). Outcomes After Cryoablation Versus Partial Nephrectomy for Sporadic Renal Tumors in a Solitary Kidney: A Propensity Score Analysis. European Urology. https://doi.org/10.1016/j.eururo.2017.09.009