Percutaneous radiofrequency ablation for renal cell carcinoma vs. partial nephrectomy: Comparison of long-term oncologic outcomes in both clear cell and non-clear cell of the most common subtype

doi:10.1016/j.urolonc.2017.03.014

Urologic Oncology: Seminars and Original Investigations

Volume 35, Issue 8, August 2017, Pages 530.e1-530.e6

https://doi.org/10.1016/j.urolonc.2017.03.014 Get rights and content

Highlights

•
For stage T1a/b non–clear cell RCC and stageT1a clear cell RCC, percutaneous radiofrequency ablation provides comparable oncologic outcomes with partial nephrectomy.
•
T1b clear cell RCC patients who treated with percutaneous radiofrequency ablation have less favorable outcomes than partial nephrectomy.
•
It is necessary to take RCC subtype into consideration when choosing percutaneous radiofrequency ablation or partial nephrectomy in the treating of RCC.

Abstract

Objectives

To compare the clinical outcomes of percutaneous radiofrequency ablation (PRFA) and partial nephrectomy (PN) in patients with clear cell renal cell carcinoma (ccRCC) and non–clear cell RCC (nccRCC) of the most common subtypes.

Materials and methods

A retrospective study was conducted to review the records of all the patients who underwent PRFA or PN between February 2005 and April 2014 at our institution. Patients with histologic confirmation of ccRCC, papillary RCC, and chromophobe RCC were included. The Mann-Whitney U test was applied to compare PRFA to PN in the ccRCC and nccRCC groups. The Kaplan-Meier method was used to generate the survival curves that were compared to the log-rank test.

Results

A total of 264 patients meeting the selection criteria were included in this study. The tumor size ranged from 0.9 to 7.0 cm. The median follow-up period was 78 months (range: 8–132 mo). Although PRFA provided comparable 10-year overall survival rates and 10-year disease-free survival (DFS) rates to PN both in ccRCC ≤4 cm and nccRCC, the 10-year DFS for patients treated with PRFA was lower than that of PN in ccRCC >4 cm. The DFS survival curve between the 2 operations and 2 subtypes was statistically significant in patients with tumor size >4 cm. Limitations include retrospective review and selection bias.

Conclusions

Patients with T1b ccRCC treated with PRFA have less favorable outcomes than those with PN whereas PRFA provides comparable oncologic outcomes to PN in patients with T1b nccRCC. It is necessary to take RCC subtypes into consideration when choosing a surgical approach to treat T1b RCC between PFRA and PN.

Introduction

With the progress in surgical techniques, nephron sparing surgery including partial nephrectomy (PN) has been widely used and is now regarded as the standard treatment for renal cell carcinoma (RCC) [1]. However, for the sake of minimally invasive therapy and maximally preserved renal function, radiofrequency ablation (RFA) has been increasingly used in treating RCC and can be applied using open, laparoscopic, and percutaneous approaches [2]. Of those 3 methods, percutaneous RFA (PRFA) has been considered the least invasive with the fastest recovery [3].

There are currently several individual RCC subtypes, and of these, the most common are clear cell RCC (ccRCC [75–85%]), papillary RCC (pRCC [10–15%]), and chromophobe RCC (chRCC [5–10%]) [4]. Achieving negative margins without residue in surgical resection is independent of tumor subtype although the biology of various RCCs can affect ablation success due to vascularity related to the “heat sink” effect during RFA [5]. Furthermore, hypovascular or avascular RCC are more likely to be categorized as non–clear cell RCC (nccRCC), especially pRCC and chRCC [6]. Therefore, our study was performed retrospectively to compare clinical and oncologic outcomes of PRFA with PN in patients with ccRCC and nccRCC of the most common subtypes.

Section snippets

Patient selection

The data were obtained from a prospectively maintained database approved by an institutional review board and ethics committee. We reviewed the records of all the patients who underwent PRFA or PN between February 2005 and April 2014 at our hospital. Patients were divided into the following 2 groups: ccRCC and nccRCC. The RCC subtype was specifically identified and only those patients with histologic confirmation of ccRCC, pRCC, and chRCC were included. Patients with synchronous bilateral,

Results

The demographics and tumor characteristics of 264 patients including 213 (80.7%) ccRCCs and 51 (19.3%) nccRCCs who met the inclusion criteria for analysis are shown in Table 1. There were 29 (56.9%) pRCCs and 22 (43.1%) chRCCs in the nccRCCs. The tumor size ranged from 0.9 to 7.0 cm. The patients in the PRFA group had a relatively higher mean American Society of Anesthesiologists (ASA) score than those in the PN group (P<0.001) in ccRCC and nccRCC alike. Moreover, the patients in the nccRCC

Discussion

With increasing applications of RFA in clinical practice, management of tumors of the bone, liver, and kidney has been reported [11], [12], [13]. As an approach of RFA, PRFA has been described as safe and effective treatment for T1 RCC in more and more recent literature, [14], [15] although surgical excision remains the gold standard for the treatment of patients with clinical T1a RCC and is widely used in T1b RCC. As we know, there are many factors that can influence PRFA success: tumor size

Conclusions

In patients with T1a/b nccRCC and T1a ccRCC, PRFA is an effective treatment option providing comparable oncologic outcomes to PN, although the DFS for T1b ccRCC treated with PRFA is lower than that of T1b nccRCC with PRFA and T1b ccRCC with PN due to tumor vascularity. The RCC subtype must be taken into consideration when PRFA is chosen as a treatment for patients with T1b RCC.

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Cited by (26)

Percutaneous ablation of renal tumors: long-term outcomes
2023, Radiologia
Valorar resultados a largo plazo de la ablación de tumores renales analizando eficacia, supervivencia a largo plazo y factores asociados con complicaciones y éxito terapéutico.
Revisión retrospectiva de 305 ablaciones, en general usando radiofrecuencia con electrodos desplegables, sobre 273 lesiones de tumores renales entre mayo de 2005 y abril de 2019. Se analizaron supervivencia, eficacia primaria y secundaria y complicaciones relacionándolas con diversos factores del paciente y características de los tumores tratados.
La creatinina en sangre media previa al tratamiento fue de 1,14 mg/dL y al año de 1,30 mg/dL (p < 0,0001). Hubo complicaciones en el 13,25% de las ablaciones (mayores, 4,97%) que se relacionaron con la edad (p = 0,013) y el diámetro tumoral (p < 0,0001). La eficacia primaria fue del 96,28%. Las lesiones de más de 4 cm fueron más propensas a presentar ablaciones incompletas (p = 0,002). La eficacia secundaria fue del 95,28%. El riesgo de recurrencia se relacionó solo con el tamaño del tumor (p = 0,02). La supervivencia global fue del 95,26% al año, 77,01% a los 5 años y 51,78% a los 10 años. No se observaron diferencias en función de la naturaleza maligna o benigna de la lesión tratada. La mortalidad aumentaba en pacientes con creatinina superior a 1 (p = 0,05) o ASA > 2 (p = 0,0001).
La ablación percutánea de tumores renales es una técnica de altísima eficacia, que permite igualar el pronóstico de un carcinoma renal, tras el tratamiento, al de una lesión benigna. Las complicaciones son muy infrecuentes y se relacionan, al igual que la supervivencia, con la edad y el estado de salud del paciente.
To evaluate the long-term outcomes of renal tumor ablation, analyzing efficacy, long-term survival, and factors associated with complications and therapeutic success.
We retrospectively reviewed 305 ablations (generally done with expandable electrodes) of 273 renal tumors between May 2005 and April 2019. We analyzed survival, primary and secondary efficacy, and complications according to various patient factors and tumor characteristics.
Mean blood creatinine was 1.14 mg/dL before treatment and 1.30 mg/dL after treatment (p < 0.0001). Complications were observed in 13.25% of the ablations, including major complications in in 4.97%. Complications were associated with age (p = 0.013) and tumor diameter (p < 0.0001). Primary efficacy was 96.28%. Incomplete ablation was more common in lesions measuring > 4 cm in diameter (p = 0.002). Secondary efficacy was 95.28%. The only factor associated with the risk of recurrence was the size of the tumor (p = 0.02). Overall survival was 95.26% at 1 year, 77.01% at 5 years, and 51.78% at 10 years, with no differences between patients with malignant and benign lesions. Mortality was higher in patients with creatinine >1 (p = 0.05) or ASA > 2 (p = 0.0001).
Percutaneous ablation is extremely efficacious for renal tumors; it improves the prognosis of renal carcinoma to the point where it does not differ from that of benign lesions. Complications are rare. Like survival, complications are associated with age and overall health status.
Results of radiofrequency on small renal masses: Complications, effects on renal fonction and oncological outcomes
2022, Progres en Urologie
La découverte de petites tumeurs du rein et leur traitement ablatif deviennent de plus en plus fréquents chez les patients ayant une contre-indication chirurgicale ou altération de la fonction rénale. Le but de cette étude a été d’évaluer l’efficacité de la radiofréquence sur ces lésions.
Une étude mono centrique rétrospective a été menée entre 2009 et 2017 sur des tumeurs du rein traitées par radiofréquence (RF). Les complications, l’impact sur la fonction rénale et les résultats oncologiques ont été évalués.
Cent trois tumeurs ont été traitées chez 96 patients. Deux patients (2 %) ont présenté des complications graves (Clavien Dindo >= 3). Le débit de filtration glomérulaire moyen était de 66 ml/min (±21 ml/min) avant procédure contre 59 ml/min(±21 ml/min) après procédure (p < 0,001). Quatre-vingt-quinze patients (99 %) n’ont pas présenté de récidive avec un suivi médian de 22,8 mois {9,6 ; 37,2}.
La radiofréquence est une technique avec peu de complications, un retentissement sur la fonction rénale modéré et efficace sur le plan carcinologique. La sélection des patients sur l’évaluation de leurs comorbidités, leur statut rénal, les données tumorales (RENAL score) est à préciser pour évaluer à long terme l’efficacité de la RF.
Finding of small renal masses and their ablative treatment has increased in patients unfit for surgery. The purpose of this study was to evaluate efficacy of Radiofrequency on those lesions.
A retrospective monocentric study of radiofrequency between 2009 and 2017 on small renal masses was undertaken. Complications, effects on renal function and oncological outcomes, were evaluated.
One hundred and three tumors were treated over 96 patients. Two patients (2%) had major complications (Clavien Dindo >= 3). Glomerular filtration rate was 66 ml/min (±21 ml/min) before procedure versus 59 ml/min (±21 ml/min) after (P < 0,001). Ninety-five patients (99%) did not present recurrence with a median follow up of 22,8 months {9,6 ; 37,2}.
Radiofrequency is a safe technique with low impact on renal function and good oncological outcomes. Selection of patients based on comorbidities, renal status, tumoral data (RENAL score) must be specified to evaluate at long term efficacy of RF.
Differential efficacy of ablation therapy versus partial nephrectomy between clinical T1a and T1b renal tumors: A systematic review and meta-analysis
2022, Urologic Oncology: Seminars and Original Investigations
Citation Excerpt :
A total of 1,440 articles were excluded after screening the titles and abstracts; a full-text review was performed for 98 articles. According to our inclusion criteria, we finally identified 27 studies comprising 13,996 patients for our meta-analysis [6,10,11,14–16,18,20,33–51]. Eighteen studies comprise cT1a patients, 6 studies comprise cT1b patients and, 3 studies comprise both cT1a and cT1b patients.
To assess the differential clinical outcomes of patients treated with partial nephrectomy (PN) vs. those treated with ablation therapy (AT) such as radiofrequency ablation, cryoablation and microwave ablation for cT1b compared to cT1a renal tumors.
Multiple databases were searched for articles published before August 2021. Studies were deemed eligible if they compared clinical outcomes in patients who underwent PN with those who underwent AT for cT1a and/or cT1b renal tumors.
Overall, 27 studies comprising 13,996 patients were eligible for this meta-analysis. In both cT1a and cT1b renal tumors, there was no significant difference in the percent decline of estimated glomerular filtration rates or in the overall/severe complication rates between PN and AT. Compared to AT, PN was associated with a lower risk of local recurrence in both patients with cT1a and cT1b tumors (cT1a: pooled risk ratio [RR]; 0.43, 95% confidence intervals [CI]; 0.28–0.66, cT1b: pooled RR; 0.41, 95%CI; 0.23–0.75). Subgroup analyses regarding the technical approach revealed no statistical difference in local recurrence rates between percutaneous AT and PN in patients with cT1a tumors (pooled RR; 0.61, 95%CI; 0.32–1.15). In cT1b, however, PN was associated with a lower risk of local recurrence (pooled RR; 0.45, 95%CI; 0.23–0.88). There was no difference in distant metastasis or cancer mortality rates between PN and AT in patients with cT1a, or cT1b tumors.
AT has a substantially relevant disadvantage with regards to local recurrence compared to PN, particularly in cT1b renal tumors. Despite the limitations inherent to the nature of retrospective and unmatched primary cohorts, percutaneous AT could be used as a reasonable alternative treatment for well-selected patients with cT1a renal tumors.
Ablative therapies versus partial nephrectomy for small renal masses – A systematic review and meta-analysis
2022, International Journal of Surgery
Citation Excerpt :
However, in a matched-cohort SEER study reported by Pecocraro et al., cancer-specific mortality is significantly worse in patients undergoing AT compared to those undergoing PN (HR 2.50, 95%CI 1.08–5.63, p = 0.03). OS was found to be similar in AT and PN group by most studies [26,28,30,32–34]contradicting the results by Andrews et al. in the study investigating percutaneous cryoablation or RFA [29]. Of the four studies reporting LRFS, two found LRFS to be similar amongst the two cohorts [29,31] while Rembeyo et al. and Yanagisawa et al. found patients undergoing percutaneous cryoablation to have significantly worse LRFS [28,34].
High quality studies and reviews on the management of small renal masses (SRM) are lacking. This review aims to compare oncological outcomes in patients undergoing ablative therapies (AT) or partial nephrectomy (PN) for T1a or T1b SRM.
Medline, EMBASE, Cochrane CENTRAL and conference proceedings were searched on the 15th July 2020 for comparative studies respective to our research question. The ROBINS-I tool and the GRADE approach were used to assess any risk of biases and certainty of evidence in the included studies. The review is registered on PROSPERO.
1,748 records were retrieved. 32 observational studies and 1 RCT integrating 74,946 patients were included. Patients undergoing AT patients are significantly older than PN patients (MD 5.70, 95%CI 3.83–7.58). In T1a patients, AT patients have significantly worse overall survival (HR 1.64, 95%CI 1.39–1.95). Local recurrence-free survival is similar with PN in patients with longer than five-years follow up (HR 1.54, 95%CI 0.88–2.71). AT patients also have similar cancer-specific survival (CSS), metastasis-free survival, disease-free survival, significantly fewer post-operative complications (RR 0.72, 95%CI 0.55–0.94), and a smaller decline in estimated glomerular filtration rate post-operatively (MD: -7.42, 95%CI -13.1 to −1.70) compared to those undergoing PN. Evidence contradicts in T1b patients for oncological outcomes.
AT have similar long-term oncological durability; lower rates of complications and superior kidney function preservation compared to PN. Given the low quality of evidence, AT is a reasonable alternative to PN in frail and co-morbid patients. Long-term high-quality studies are needed to confirm the potential benefits of AT, especially in T1b patients.
CRD42020199099.
Papillary renal cell carcinoma: Review
2021, Urologic Oncology: Seminars and Original Investigations
Kidney cancer is the 13th most common malignancy globally, and the incidence is rising. Papillary renal cell carcinoma is the second most common subtype, comprising 10-15% of renal cell carcinomas. Though the histologic features of this subtype were initially described in the 1990’s, our understanding of the genetic and molecular characteristics of this disease have rapidly evolved over the past decade. In this review, we summarize the contemporary understanding of the clinical, morphologic, radiographic, and genetic characteristics of papillary renal cell carcinoma, as well as clinical considerations, current options for management, and prognosis.
Long-Term Survival after Percutaneous Radiofrequency Ablation of Pathologically Proven Renal Cell Carcinoma in 100 Patients
2020, Journal of Vascular and Interventional Radiology
Citation Excerpt :
Reported 5-year overall survival rates for all treated RCCs range from 60% (27) to 80% (25). Ten-year overall survival rates are reported less frequently, but have ranged from 64% (15) to 85% (18). The 10-year survival estimate of 34% in the present study is below the published range, possibly reflecting advanced age and cohort selection bias for patients with multiple comorbidities.
To determine the long-term survival of patients treated with percutaneous radiofrequency (RF) ablation for pathologically proven renal cell carcinoma (RCC).
In this single-center retrospective study, 100 patients with 125 RCCs (100 clear-cell, 19 papillary, and 6 chromophobe) 0.8–8 cm in size treated with RF ablation were evaluated at a single large tertiary-care center between 2004 and 2015. Technical success, primary and secondary technique efficacy, and pre- and postprocedural estimated glomerular filtration rate (eGFR) at 3–6 months and 2–3 years were recorded. Overall survival, cancer-specific survival, and local tumor progression–free survival were calculated by Kaplan–Meier survival curves. Complications were classified per the Clavien–Dindo system. Statistical testing was done via χ² tests for proportions and paired t test for changes in eGFR. Statistical significance was set at α = 0.05.
Overall technical success rate was 100%, and primary and secondary technique efficacy rates were 90% and 100%, respectively. Median follow-up was 62.8 months, ranging from 1 to 120 months. The 10-year overall, cancer-specific, and local progression–free survival rates were 32%, 86%, and 92%, respectively. The number of ablation probes used was predictive of residual unablated tumor (P < .001). There were no significant changes in preprocedure vs 2–3-years postprocedure eGFR (65.2 vs 62.1 mL/min/1.73 m²; P = .443). There was a 9% overall incidence of complications, the majority of which were grade I.
Image-guided percutaneous RF ablation of RCCs is effective at achieving local control and preventing cancer-specific death within 10 years from initial treatment.

View all citing articles on Scopus

^☆: This work was supported by a Grant from National Natural Science Foundation of China (ID: 81572512). This research did not receive any specific grant from funding agencies in the public, commercial, and not-for-profit sectors.

¹: Both the authors contributed equally to the study.

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Original articlePercutaneous radiofrequency ablation for renal cell carcinoma vs. partial nephrectomy: Comparison of long-term oncologic outcomes in both clear cell and non-clear cell of the most common subtype☆

Highlights

Abstract

Objectives

Materials and methods

Results

Conclusions

Introduction

Section snippets

Patient selection

Results

Discussion

Conclusions

Urol Oncol

J Urol

Eur Urol

J Urol

J Urol

J Urol

Biochim Biophys Acta

J Urol

National trends in the utilization of partial nephrectomy before and after the establishment of AUA guidelines for the management of renal masses

Urology

Improved outcome of percutaneous radiofrequency ablation in renal cell carcinoma: a retrospective study of intraoperative contrast-enhanced ultrasonography in 73 patients

Abdom Imaging

Image-guided radiofrequency ablation of renal cell carcinoma

Eur Radiol

Histological features of hypovascular or avascular renal cell carcinoma: the experience at four university hospitals

Int J Clin Oncol

Percutaneous radiofrequency ablation with contrast-enhanced ultrasonography for solitary and sporadic renal cell carcinoma in patients with autosomal dominant polycystic kidney disease

World J Surg Oncol

Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey

Ann Surg

Renal function outcomes in patients treated for renal masses smaller than 4 cm by ablative and extirpative techniques

J Urol

Radiofrequency Ablation for Liver Cancer

Radiol Technol

Original article
Percutaneous radiofrequency ablation for renal cell carcinoma vs. partial nephrectomy: Comparison of long-term oncologic outcomes in both clear cell and non-clear cell of the most common subtype☆