Management of Renal Masses and Localized Renal Cancer: Systematic Review and Meta-Analysis

Abstract

Purpose-Several options exist for management of clinically localized renal masses suspicious for cancer, including active surveillance, thermal ablation and radical or partial nephrectomy. We summarize evidence on effectiveness and comparative effectiveness of these treatment approaches for patients with a renal mass suspicious for localized renal cell carcinoma. Materials and Methods-We searched MEDLINE®, Embase® and the Cochrane CentralRegister of Controlled Trials from January 1, 1997 through May 1, 2015. Paired investigators independently screened articles to identify controlled studies of management options or cohort studies of active surveillance, abstracted data sequentially and assessed risk of bias independently. Strength of evidence was graded by comparisons.Results-The search identified 107 studies (majority T1, no active surveillance or thermal ablation stratified outcomes of T2 tumors). Cancer specific survival was excellent among all management strategies (median 5-year survival 95%). Local recurrence-free survival was inferior for thermal ablation with 1 treatment but reached equivalence to other modalities after multiple treatments. Overall survival rates were similar among management strategies and varied with age and comorbidity. End-stage renal disease rates were low for all strategies (0.4% to 2.8%). Radical nephrectomy was associated with the largest decrease in estimated glomerular filtration rate and highest incidence of chronic kidney disease. Thermal ablation offered the most favorable perioperative outcomes. Partial nephrectomy showed the highest rates of urological complications but overall rates of minor/major complications were similar among interventions. Strength of evidence was moderate, low and insufficient for 11, 22 and 30 domains, respectively. * Correspondence: 600 N. Wolfe St., Park Building, Room 223, Baltimore, Maryland 21287 (telephone: 618-534-4942; FAX: 410-502-7711; hitenpatel@jhmi.edu). No direct or indirect commercial incentive associated with publishing this article.The corresponding author certifies that, when applicable, a statement(s) has been included in the manuscript documenting institutional review board, ethics committee or ethical review board study approval; principles of Helsinki Declaration were followed in lieu of formal ethics committee approval; institutional animal care and use committee approval; all human subjects provided written informed consent with guarantees of confidentiality; IRB approved protocol number; animal approved project number.References 51 through 88 can be obtained at http://jurology.com/. HHS Public Access METHODS Data Sources and SearchesWe report results from a broader systematic review. Data Synthesis and AnalysisAll studies were summarized qualitatively. LRFS was defined as the absence of any persistent or recurrent disease in the treated region of the kidney or associated renal fossa after a single, curative intent initial treatment. This definition included persistent enhancement of any treated mass, a visually e...

Skin-to-tumor Distance Predicts Treatment Failure of T1A Renal Cell Carcinoma Following Percutaneous Cryoablation

“…PCA preserves renal parenchyma and minimizes morbidity, convalescence time, and costs versus surgical excision 20,21 . Moreover, PCA offers similar cancer specific and metastasis free survival to the gold standard, partial nephrectomy 9 . Still, reported local treatment failure after PCA is higher than with surgical extirpation indicating that better patient selection or improved ablation techniques are needed.…”

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“…While local recurrencefree survival was worse for a single session of thermal ablation (HR 0.37, 95% CI 0.15-0.89), having repeat ablations levelled out the difference between this treatment modality and PN [70]. This is an important point to consider, as it reassures that retreatment with ablation or surgery is still a viable cancer control option after ablation-associated recurrence.…”

“…A recent meta-analysis of 60 studies comparing treatment modalities in renal tumours with less than 7cm showed that cancer-specific and metastasis-free survival at 5 years were similar between PN and thermal ablation [70]. While local recurrencefree survival was worse for a single session of thermal ablation (HR 0.37, 95% CI 0.15-0.89), having repeat ablations levelled out the difference between this treatment modality and PN [70].…”

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