Population‐based assessment of cancer‐specific mortality after local tumour ablation or observation for kidney cancer: a competing risks analysis

Larcher, Alessandro; Trudeau, Vincent; Sun, Maxine; Boehm, Katharina; Meskawi, Malek; Tian, Zhe; Fossati, Nicola; Dell’Oglio, Paolo; Capitanio, Umberto; Briganti, Alberto; Shariat, Shahrokh F.; Montorsi, Francesco; Karakiewicz, Pierre I.

doi:10.1111/bju.13326

Cited by 16 publications

(11 citation statements)

References 30 publications

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“…Thermal ablation might be a superior alternative to active surveillance even in older and frail patients (22). However, recent results by Kokabi et al (13) suggested that despite these recommendations, thermal ablation might be underused in eligible populations.…”

Section: Discussionmentioning

confidence: 99%

Ablation versus Resection for Stage 1A Renal Cell Carcinoma: National Variation in Clinical Management and Selected Outcomes

Uhlig¹,

Kokabi²,

Xing³

et al. 2018

Radiology

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Purpose To compare patients in a national U.S. database who underwent thermal ablation or nephrectomy for renal cell carcinoma (RCC) in terms of demographic differences, perioperative outcomes, and survival. Materials and Methods This National Cancer Database study included patients who underwent thermal ablation or nephrectomy for biopsy-proven T1aN0M0 RCC between 2004 and 2013. Demographic factors were analyzed as treatment predictors. Unplanned hospital readmission, mean hospital stay, 30- and 90-day postoperative mortality, and survival were analyzed in a propensity score-matched cohort by using χ tests, Cox proportional hazards models, and Renyi family tests. Results Included were 4817 of 56 065 patients (8.6%) who underwent thermal ablation and 51 248 of 56 065 patients (91.4%) who underwent nephrectomy. Patients who underwent thermal ablation skewed older (mean, 52 years vs 44 years, respectively) with more comorbidities (9% vs 7.6% Charlson Comorbidity Index score of ≥2, respectively). Male sex, white race, nonprivate insurance, therapy at academic centers, and south Atlantic state urban residence with lower income and education were associated with higher thermal ablation treatment likelihood (P < .001). After matching, perioperative outcomes were superior for thermal ablation: unplanned hospital readmission, mean hospital stay, and 30- and 90-day postoperative mortality were lower for thermal ablation (2% vs 3.3%, 1.3 days vs 4.3 days, 0% vs 0.9%, and 0% vs 1.4%, respectively; each P < .001). Survival was comparable for thermal ablation and nephrectomy in patients older than 65 years, and during the 1st postoperative year for all patients. Conclusion Thermal ablation for RCC varied by national region and with multiple clinical and nonclinical demographic factors. Thermal ablation demonstrates superior perioperative outcomes with short mean hospital stay, low unplanned hospital readmission, and 30- and 90-day mortality. In selected patients, thermal ablation survival may be comparable to nephrectomy.

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Section: Discussionmentioning

confidence: 99%

Ablation versus Resection for Stage 1A Renal Cell Carcinoma: National Variation in Clinical Management and Selected Outcomes

Uhlig¹,

Kokabi²,

Xing³

et al. 2018

Radiology

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“…According to Lane BR et al [20], although no difference was observed in cancer-specific mortality between AS and NSI (PN and TA), there were apparent differences in characteristics of patients and tumors between the comparing groups, and the proportion of malignancy in AS might be diluted to an unknown extent. Nevertheless, a study by Larcher A et al [17] mentioned that after adjustment for other cause mortality and various characteristics of patients and tumors, TA seemed to be associated with a protective effect on cancer specific mortality when compared with observation, and resulted in acceptable peri-operative morbidity [21]. We also noted that PN demonstrated better OS than AS, while TA did not.…”

Section: Discussionmentioning

confidence: 60%

“…Seven studies addressed to CSS, of which two were studies of the SEER dataset [17, 18]. The combined HR of these studies revealed that NSI was associated with a statistically significant CSS benefit compared with AS for patients with renal masses (HR = 0.64, 95%CI: 0.46–0.89, P < 0.001) with apparent inter-study heterogeneity ( I 2 = 54%, Chi 2 = 13.10, P = 0.04) (Fig.…”

Section: Resultsmentioning

confidence: 99%

Comparison of survival benefits of nephron-sparing intervention or active surveillance for patients with localized renal masses: a systematic review and meta-analysis

Guo

2019

BMC Urol

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Background Strong evidence comparing effectiveness between nephron-sparing intervention (NSI) and active surveillance (AS) is lacking. Thus, we aim to compare the outcomes of survival, including cancer-specific survival (CSS), overall survival (OS), and cardiovascular-specific survival (CVSS), in patients with renal masses who underwent NSI or AS. Methods A systematic literature search of PubMed, Web of Science, and EMBASE was performed for citations published prior to September 2018 that described NSI, partial nephrectomy and thermal ablation included, and AS for patients with renal masses and a standard meta-analysis on survival outcomes was then conducted. Results The meta-analysis included seven studies containing 5809 patients. The results comparing NSI with AS were as follows: CSS (hazard ratio (HR) = 0.64, 95% confidence interval (CI): 0.46–0.89, P < 0.001), OS (HR = 0.46, 95%CI: 0.39–0.53, P < 0.001), and CVSS (HR = 0.37, 95%CI: 0.24–0.57, P < 0.001). Conclusions This systematic review and meta-analysis indicates that NSI is associated with better OS, CSS and CVSS when compared with AS for patients with renal masses. Further better prospective cohort studies are needed to make definitive statements about these different treatment methods.

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“…Conversely, some studies have reported clinical outcomes to 5 years. Cancer-specific survival after IGTA of T1a RCC ranges from 96% to 100% with a weighted mean of 97% (15,22,23,68,69,76). The threshold for cancer-specific survival of IGTA for T1a RCC is 94%.…”

Section: Discussionmentioning

confidence: 99%

Society of Interventional Radiology Quality Improvement Standards on Percutaneous Ablation in Renal Cell Carcinoma

Gunn

Parikh

Bhatia

2020

Journal of Vascular and Interventional Radiology

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Population‐based assessment of cancer‐specific mortality after local tumour ablation or observation for kidney cancer: a competing risks analysis

Abstract: After adjustment for comorbidity and tumour characteristics in elderly patients with kidney cancer, LTA was associated with a clinically and statistically significant protective effect on CSM, compared with OBS. This advantage of LTA deserves consideration when obtaining informed consent.

Cited by 16 publications

References 30 publications

Ablation versus Resection for Stage 1A Renal Cell Carcinoma: National Variation in Clinical Management and Selected Outcomes

Ablation versus Resection for Stage 1A Renal Cell Carcinoma: National Variation in Clinical Management and Selected Outcomes

Comparison of survival benefits of nephron-sparing intervention or active surveillance for patients with localized renal masses: a systematic review and meta-analysis

Society of Interventional Radiology Quality Improvement Standards on Percutaneous Ablation in Renal Cell Carcinoma

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