Comparison of Partial Nephrectomy and Percutaneous Ablation for cT1 Renal Masses
| Autor: | John C. Cheville, Grant D. Schmit, Sarah P. Psutka, Bradley C. Leibovich, Matthew R. Callstrom, Suzanne B. Stewart, A. Nicholas Kurup, T.D. Atwell, Christine M. Lohse, Stephen A. Boorjian, Adam J. Weisbrod, R. Houston Thompson |
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| Rok vydání: | 2015 |
| Předmět: |
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medicine.medical_specialty Time Factors Percutaneous Ablation Techniques Radiofrequency ablation Minnesota Urology medicine.medical_treatment Kaplan-Meier Estimate Cryosurgery Nephrectomy Disease-Free Survival law.invention Risk Factors law Humans Medicine Registries Carcinoma Renal Cell Aged Neoplasm Staging Proportional Hazards Models Retrospective Studies Aged 80 and over business.industry Cryoablation Middle Aged Ablation Kidney Neoplasms Tumor Burden Surgery Treatment Outcome Cohort Catheter Ablation Disease Progression Female Neoplasm Recurrence Local business |
| Zdroj: | European Urology. 67:252-259 |
| ISSN: | 0302-2838 |
| DOI: | 10.1016/j.eururo.2014.07.021 |
| Popis: | Background Partial nephrectomy (PN) is a preferred treatment for cT1 renal masses, whereas thermal ablation represents an alternative nephron-sparing option, albeit with higher reported rates of recurrence. Objective To review our experience with PN, percutaneous radiofrequency ablation (RFA), and percutaneous cryoablation for cT1 renal masses. Design, setting, and participants A total of 1803 patients with primary cT1N0M0 renal masses treated between 2000 and 2011 were identified from the prospectively maintained Mayo Clinic Renal Tumor Registry. Intervention PN compared with percutaneous ablation. Outcome measurements and statistical analysis Local recurrence-free, metastases-free, and overall survival rates were estimated using the Kaplan-Meier method and compared with log-rank tests. Results and limitations Of the 1424 cT1a patients, 1057 underwent PN, 180 underwent RFA, and 187 underwent cryoablation. In this cohort, local recurrence-free survival was similar among the three treatments ( p =0.49), whereas metastases-free survival was significantly better after PN ( p =0.005) and cryoablation ( p =0.021) when compared with RFA. Of the 379 cT1b patients, 326 patients underwent PN, and 53 patients were managed with cryoablation (8 RFA patients were excluded). In this cohort, local recurrence-free survival ( p =0.81) and metastases-free survival ( p =0.45) were similar between PN and cryoablation. In both the cT1a and cT1b groups, PN patients were significantly younger, with lower Charlson scores and had superior overall survival ( p Conclusions In a large cohort of sporadic cT1 renal masses, we observed that recurrence-free survival was similar for PN and percutaneous ablation patients. Metastases-free survival was superior for PN and cryoablation patients when compared with RFA for cT1a patients. Overall survival was superior after PN, likely because of selection bias. If these results were validated, an update to clinical guidelines would be warranted. Patient summary Partial nephrectomy and percutaneous ablation for small ( |
| Databáze: | OpenAIRE |
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