Comparing Outcomes for Patients with Clinical T1b Renal Cell Carcinoma Treated With Either Percutaneous Microwave Ablation or Surgery

Shapiro, Daniel D.; Wells, Shane A.; Best, Sara L.; Hedican, Sean P.; Ziemlewicz, Timothy J.; Lubner, Meghan G.; Hinshaw, J. Louis; Lee, Fred T.; Jarrard, David F.; Richards, Kyle A.; Downs, Tracy M.; Allen, Glenn O.; Nakada, Stephen Y.; Abel, E. Jason

doi:10.1016/j.urology.2019.09.024

Cited by 32 publications

(32 citation statements)

References 29 publications

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“…The cohort of patients undergoing MWA with T1b disease was small (11 patients); however, the LOS and complication rate was concordant with the T1a cohort. No current guidelines recommend ablative therapies for T1b disease; however, its feasibility has been demonstrated in comorbid patients, with an estimated 5‐year RFS of 94.5% [29]. In the large Mayo clinic series with mature follow‐up, metastasis‐free survival and CSS appeared to be worse for CA compared to PN, although this did not reach statistical significance [14].…”

Section: Discussionmentioning

confidence: 99%

Percutaneous microwave ablation of renal masses in a UK cohort

et al. 2020

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Objectives To report a tertiary referral centre’s experience of microwave ablation (MWA) for suspected renal cell carcinoma (RCC), describing complications and oncological outcomes. Patients and Methods Consecutive MWA procedures (n = 113) for renal masses (October 2016 to September 2019) were maintained on a prospective database. Data describing patient, disease, procedure, complications, and oncological outcomes were analysed. Results The median (range) age was 68 (33–85) years, 73% were male, and the median Charlson Comorbidity Index was 0. The median (interquartile range [IQR]) tumour diameter was 25 (20–32) mm. In all, 95% had renal mass biopsy, with histologically confirmed cancer in 75%. The median (IQR) R.E.N.A.L. (Radius, Exophytic/Endophytic, Nearness, Anterior/Posterior, Location) nephrometry score was 7 (6–8). The median ablation time was 6 min and length of stay was 1 day for 95% of the patients. Clavien–Dindo complication Grades I, II, IIIb and IV occurred in 18%, 1.8%, 0.9% and 0.9%, respectively. The median follow‐up was 12 months and the median (IQR) renal function change was −4 (−18 to 0)%. One patient (0.9%) had local recurrence, treated with re‐ablation; two developed metastatic progression; and two (1.8%) had indeterminate findings on follow‐up (one lung nodule and one possible local recurrence), managed with ongoing protocolised computed tomography surveillance. Post‐procedure complications were associated with total ablation time (odds ratio [OR] 1.152/min, 95% confidence interval [CI] 1.040–1.277) and total ablation energy (OR 1.017/kJ, 95% CI 1.001–1.033). Conclusions We describe the largest UK series of MWA treatment for T1a/small T1b renal masses to date. MWA was well tolerated, with 95% discharged the following day and low complication/re‐admission rates. Current follow‐up demonstrates favourable disease control. MWA appears to be safe and effective and should be considered in future prospective comparisons of treatments for T1a/small T1b renal masses.

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Section: Discussionmentioning

confidence: 99%

Percutaneous microwave ablation of renal masses in a UK cohort

et al. 2020

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“…MWA relies on the continuous realignment of polar molecules (primarily water) with the oscillating microwave field, increasing kinetic energy and tissue temperature [30,31]. Two included studies used microwaves: Shapiro et al [12] and Guo et al [15]. Sixty-three patients received this treatment.…”

Section: Ablation Methodsmentioning

confidence: 99%

“…Homogenous, smooth, and low-level enhancement may be seen on post-ablation imaging without corresponding to recurrence [20]. This was assessed by contrast-enhanced CT or MRI between 1 week after the procedure [10] to 6 months after [12]. Secondary TE was defined as TE after multiple treatments of image-guided tumor ablation [21].…”

Section: Analysis Techniquementioning

confidence: 99%

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Local recurrence and other oncologic outcomes after percutaneous image-guided tumor ablations on stageT1b renal cell carcinoma: a systematic review and network meta-analysis

Cazalas

Jambon

Coussy

et al. 2021

International Journal of Hyperthermia

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Objective: A systematic review of clinical trials on thermal ablation of T1b RCC was conducted to assess oncologic outcomes of those procedures. The primary endpoint was the rate of local recurrence. Secondary endpoints included technical efficacy, progression to metastatic disease, cancer-specific mortality, complications and renal function decrease. Methods: PubMed (MEDLINE) and Embase databases were searched in June 2020 for eligible trials following the PRISMA selection process. Prevalence of local recurrence and per procedural major adverse effects were calculated using double arcsine transformation and a random-effects model. Results: Nine clinical trials (all retrospective) involving 288 patients with T1b renal clear cell carcinoma treated with either percutaneous microwave ablation, cryoablation or radiofrequency ablation were analyzed. Using a random-effects model, the overall prevalence of local recurrence following percutaneous ablation was 0.08 (0.04-0.14; p ¼ 0.05). Primary technical efficacy was 226/263 (86%) patients and secondary technical efficacy was 247/263 (94%). Overall, 10/176 (6%) patients presented metastatic locations following the ablation. Major adverse effects prevalence was 0.09 (0.06-0.14; p ¼ 0.05). Conclusions: Thermal ablations are feasible, safe, and effective to treat T1b renal clear cell carcinoma. More trials are necessary to determine the rate of the evidence of the benefit. HIGHLIGHTSThermal ablations are feasible and safe to treat T1b renal clear cell carcinoma. Oncologic outcomes appear to be very good on both local control and distant progression. Due to small number and heterogeneity of studies more trials are necessary to determine the rate of the evidence of the benefit.

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“…2 Our research validates the trend that the application of LA has increased over time, from 8.1% in 2004 to 14.9% in 2016. Previous studies compared the early or longterm oncological outcomes, renal function, and complications between patients treated with LA and PN 12,14,16,17,[23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40] ; some are summarized in Table 3. These studies suggested that when selecting patients, those treated with LA or PN showed comparable oncological outcomes and equivalent or better kidney function preservation.…”

Section: Discussionmentioning

confidence: 99%

Local ablation vs partial nephrectomy in T1N0M0 renal cell carcinoma: An inverse probability of treatment weighting analysis

Shi

Liu

et al. 2020

Cancer Medicine

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Objective To compare the survival outcomes of local ablation (LA) and partial nephrectomy (PN) for T1N0M0 renal cell carcinoma (RCC). Method We identified 38,155 T1N0M0 RCC patients treated with PN or LA in 2004‐2016 from the retrospective Surveillance, Epidemiology, and End Results databases. Among them, there were 4656 LA and 33,499 PN. A Cox proportional hazards regression model, cause‐specific Cox regression and Fine and Gray sub‐distribution hazard ratio (sHR) with inverse probability of treatment weighting (IPTW) adjusting was utilized to compare the effects of LA vs PN on all‐, RCC‐, and non‐RCC–caused mortality. Results Within the IPTW analysis, patients who underwent PN experienced a better overall survival (OS) (HR, 1.56; 95% CI, 1.40‐1.74; P < .001) and cancer‐specific survival (CSS) (HR, 2.21; 95% CI, 1.62‐2.98; P < .001) than LA patients. In the subgroup of patients >85 years (HR, 1.14; 95% CI, 0.73‐1.79, P = .577), chromophobe RCC (HR, 1.68; 95% CI, 0.94‐3.00, P = .078), and tumor size <2 cm (HR, 1.21; 95% CI, 0.95‐1.53, P = .126), the OS showed no significant difference between LA and PN. No significant difference in CSS between LA and PN was observed in the subgroup of chromophobe RCC (HR, 0.34; 95% CI, 0.03‐3.97, P = .389), and tumor size <2 cm (HR, 1.83; 95% CI, 0.92‐3.64, P = .084). For patients >85 years (sHR, 0.89; 95% CI, 0.52‐1.27, P = .520) and tumor size <2 cm (sHR, 1.14; 95% CI, 0.94‐1.38, P = .200), the non‐RCC–specific mortality was not significantly different in PN and LA cohorts, however, for the chromophobe RCC, the LA showed a worse non‐RCC mortality than PN (HR, 1.72; 95% CI, 1.06‐2.79, P = .028). Conclusion PN showed a better prognosis than LA in T1N0M0 RCC treatment, but LA and PN showed a comparable OS in elderly patients (>85), small RCC (<2 cm) and chromophobe RCC.

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Comparing Outcomes for Patients with Clinical T1b Renal Cell Carcinoma Treated With Either Percutaneous Microwave Ablation or Surgery

Cited by 32 publications

References 29 publications

Percutaneous microwave ablation of renal masses in a UK cohort

Percutaneous microwave ablation of renal masses in a UK cohort

Local recurrence and other oncologic outcomes after percutaneous image-guided tumor ablations on stageT1b renal cell carcinoma: a systematic review and network meta-analysis

Local ablation vs partial nephrectomy in T1N0M0 renal cell carcinoma: An inverse probability of treatment weighting analysis

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