Minimally invasive nephron-sparing treatments for T1 renal cell cancer in patients over 75 years: a comparison of outcomes after robot-assisted partial nephrectomy and percutaneous ablation.

Autor: Lehrer R; Department of Radiology, Sorbonne Université, AP-HP, Hôpital Tenon, Paris, France.; Department of Interventional Radiology, Sorbonne Université, Paris, France., Cornelis F; Radiology Department, Memorial Sloan Kettering Cancer Center, New York, USA.; French Research Network on Kidney Cancer UroCCR, Bordeaux, France., Bernhard JC; French Research Network on Kidney Cancer UroCCR, Bordeaux, France.; Department of Urology, Hôpital Pellegrin, Bordeaux University Hospital, Bordeaux, France., Bigot P; French Research Network on Kidney Cancer UroCCR, Bordeaux, France.; Department of Urology, Angers University Hospital, Angers, France., Champy C; Department of Urology, University Hospital Henri Mondor, AP-HP, Créteil, France.; INSERM, U1430, Henri Mondor University Hospital, AP-HP, 94000, Creteil, France., Bruyère F; French Research Network on Kidney Cancer UroCCR, Bordeaux, France.; Department of Urology, Tours University Hospital, Tours, France., Rouprêt M; French Research Network on Kidney Cancer UroCCR, Bordeaux, France.; Department of Urology, Pitié-Salpêtrière Hospital, Sorbonne University, AP-HP, Paris, France., Doumerc N; French Research Network on Kidney Cancer UroCCR, Bordeaux, France.; Department of Urology, University Hospital Rangueil, Toulouse, France., Bensalah CK; French Research Network on Kidney Cancer UroCCR, Bordeaux, France.; Department of Urology, Rennes University Hospital, Rennes, France., Olivier J; Department of Urology, Lille University Hospital, Lille, France., Audenet F; French Research Network on Kidney Cancer UroCCR, Bordeaux, France.; Department of Urology, Hôpital Européen Georges Pompidou, AP-HP, Paris, France., Tricard T; Department of Urology, Nouvel Hôpital Civil, Strasbourg, France., Parier B; Department of Urology, Bicêtre University Hospital, AP-HP, Le Kremlin-Bicêtre, France., Durand X; Department of Urology, Paris Saint-Joseph Hospital, Paris, France., Durand M; Department of Urology, Hôpital Pasteur 2, Nice, France.; INSERM U1081 - CNRS, UMR 7284, Université de Nice Côte d'Azur, Nice, France., Charles T; French Research Network on Kidney Cancer UroCCR, Bordeaux, France.; Department of Urology, Poitiers University Hospital, Poitiers, France., Branger N; Department of Urology, Institut Paoli-Calmettes Cancer Centre, Marseille, France., Surlemont L; Department of Urology, Rouen University Hospital, Rouen, France., Xylinas E; French Research Network on Kidney Cancer UroCCR, Bordeaux, France.; Department of Urology, Bichat-Claude Bernard Hospital, AP-HP, Paris, France., Beauval JB; French Research Network on Kidney Cancer UroCCR, Bordeaux, France.; Department of Urology, Grenoble University Hospital, Grenoble, France., Barral M; Department of Radiology, Sorbonne Université, AP-HP, Hôpital Tenon, Paris, France. matthias.barral@aphp.fr.; Department of Interventional Radiology, Sorbonne Université, Paris, France. matthias.barral@aphp.fr.; Service d'Imagerie Radiologiques et Interventionnelles Spécialisées, Hôpital Tenon, Sorbonne Université, AP-HP, 4 rue de la chine, 75020, Paris, France. matthias.barral@aphp.fr.
Jazyk: angličtina
Zdroj: European radiology [Eur Radiol] 2023 Dec; Vol. 33 (12), pp. 8426-8435. Date of Electronic Publication: 2023 Jul 19.
DOI: 10.1007/s00330-023-09975-5
Abstrakt: Purpose: To compare the oncological and perioperative outcomes of robot-assisted partial nephrectomy (RPN) and percutaneous thermal ablation (PTA) for treatment of T1 renal cell cancer (RCC) in patients older than 75 years.
Materials and Methods: Retrospective national multicenter study included all patients older than 75 years treated for a T1 RCC by RPN or PTA between January 2010 and January 2021. Patients' characteristics, tumor data, and perioperative and oncological outcomes were compared.
Results: A total of 205 patients for 209 procedures (143 RPN and 66 PTA) were included. In the PTA group, patients were older (80.4 ± 3.7 vs. 79 ± 3.7 years (p = 0.01)); frailer (ASA score (2.43 ± 0.6 vs. 2.17 ± 0.6 (p < 0.01)); and more frequently had a history of kidney surgery (16.7% [11/66] vs. 5.6% [8/143] (p = 0.01)) than in the RPN group. Tumors were larger in the RPN group (2.7 ± 0.7 vs. 3.2 ± 0.9 cm (p < 0.01)). Operation time, length of hospital stay, and increase of creatinine serum level were higher in RPN (respectively 92.1 ± 42.7 vs. 150.7 ± 61.3 min (p < 0.01); 1.7 ± 1.4 vs. 4.2 ± 3.4 days (p < 0.01); 1.9 ± 19.3% vs. 10.1 ± 23.7 (p = 0.03)). Disease-free survival and time to progression were similar (respectively, HR 2.2; 95% CI 0.88-5.5; p = 0.09; HR 2.1; 95% CI 0.86-5.2; p = 0.1). Overall survival was shorter for PTA that disappeared after Cox adjusting model (HR 3.3; 95% CI 0.87-12.72; p = 0.08).
Conclusion: Similar oncological outcomes are observed after PTA and RPN for T1 RCC in elderly patients.
Clinical Relevance Statement: Robot-assisted partial nephrectomy and percutaneous thermal ablation have similar oncological outcomes for T1a kidney cancer in patients over 75 years; however, operative time, decrease in renal function, and length of hospital stay were lower with ablation.
Key Points: • After adjusting model for age and ASA score, similar oncological outcomes are observed after percutaneous thermal ablation and robot-assisted partial nephrectomy for T1 renal cell cancer in elderly patients. • Operation time, length of hospital stay, and increase of creatinine serum level were higher in the robot-assisted partial nephrectomy group.
(© 2023. The Author(s), under exclusive licence to European Society of Radiology.)
Databáze: MEDLINE
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