Abstract
Objective
To analyze risk factors and patterns of RCC recurrence following percutaneous ablation
for stage 1 tumors and develop risk-stratified follow-up imaging protocols.
Method
Biopsy-proven sporadic stage 1 RCC patients treated with percutaneous microwave ablation
(MWA) or cryoablation (CA) from 2002 to 2017 were included. Kaplan-Meier analysis
was used to estimate local and distant recurrence-free survival, cancer-specific survival
and metastatic-free survival. Multivariable models were used to identify risk factors
associated with recurrence.
Results
A total of 256 patients with stage 1 RCC (215 T1a, 41 T1b) were treated with percutaneous
MWA (178 subjects) or CA (78 subjects). Recurrence was identified in 23 patients (16
local, 7 distant). Clinical T stage (HR 2.46, 95% CI 1.06-5.72, P = .04) and tumor grade (HR 4.17, 95% CI 1.17-14.76, P = .03) were independent predictors of recurrence. Recurrence was not associated with
Nephrometry score, cystic tumors, ablation modality (CA vs MWA) or gender. Five-year
cancer-specific survival, and metastatic-free survival were 98.6% and 97.4%, respectively.
Patients were stratified into 2 groups: reduced risk stage 1 (no risk factors) or
elevated risk stage 1 (≥1 risk factor). Recurrence risk was higher in the elevated-risk
group (HR = 3.19, 95% CI 1.35-7.53, P = .008). Five-year overall recurrence-free survival (local + distant) was higher
in reduced-risk vs elevated-risk cohorts, 88% vs 69%, P = .005.
Conclusion
High nuclear grade or T1b tumors have increased recurrence risk following percutaneous
thermal ablation for stage 1 RCC. Current postablation follow-up protocols may be
modified for individual recurrence risk to allow more frequent imaging for elevated-risk
patients, while enabling less frequent imaging for reduced-risk patients.
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References
- The temporal association of robotic surgical diffusion with overtreatment of the small renal mass.J Urol. 2018; 200: 981-988
- Thermal ablation vs surgery for localized kidney cancer: a surveillance, epidemiology, and end results (SEER) database analysis.Urology. 2011; 78: 93-98
- Renal mass and localized renal cancer: AUA guideline.J Urology. 2017; 198: 520-529
- Management of small renal masses: American Society of Clinical Oncology Clinical Practice Guideline.J Clin Oncol Offic J Am Soc Clin Oncol. 2017; 35: 668-680
- Management of renal masses and localized renal cancer: systematic review and meta-analysis.J Urol. 2016; 196: 989-999
- Long-term oncologic outcomes after radiofrequency ablation for T1 renal cell carcinoma.Eur Urol. 2013; 63: 486-492
- Comparison of partial nephrectomy and percutaneous ablation for cT1 renal masses.Eur Urol. 2015; 67: 252-259
- Laparoscopic vs percutaneous cryoablation for the small renal mass: 15-year experience at a single center.Urology. 2015; 85: 850-855
- Oncologic efficacy of radio frequency ablation for small renal masses: clear cell vs papillary subtype.J Urol. 2015; 194: 653-657
- Ten-year outcomes of renal tumor radiofrequency ablation.J Urol. 2018;
- Long-term outcomes of renal tumor radio frequency ablation stratified by tumor diameter: size matters.J Urol. 2012; 187: 1183-1189
- Effect of tumor complexity and technique on efficacy and complications after percutaneous microwave ablation of stage T1a renal cell carcinoma: a single-center, retrospective study.Radiology. 2017; 284: 272-280
- The R.E.N.A.L. nephrometry score: a comprehensive standardized system for quantitating renal tumor size, location and depth.J Urol. 2009; 182: 844-853
- Comparison of percutaneous and laparoscopic cryoablation for the treatment of solid renal masses.AJR Am J Roentgenol. 2008; 191: 1159-1168
- Image-guided tumor ablation: standardization of terminology and reporting criteria–a 10-year update.Radiology. 2014; 273: 241-260
- The probability of aggressive versus indolent histology based on renal tumor size: implications for surveillance and treatment.Eur Urol. 2018; 74: 489-497
- Postoperative surveillance protocol for patients with localized and locally advanced renal cell carcinoma based on a validated prognostic nomogram and risk group stratification system.J Urol. 2005; 174 (discussion 472; quiz 801): 466-472
- Prediction of progression after radical nephrectomy for patients with clear cell renal cell carcinoma: a stratification tool for prospective clinical trials.Cancer. 2003; 97: 1663-1671
- A postoperative prognostic nomogram predicting recurrence for patients with conventional clear cell renal cell carcinoma.J Urol. 2005; 173: 48-51
- Diagnostic accuracy and risks of biopsy in the diagnosis of a renal mass suspicious for localized renal cell carcinoma: systematic review of the literature.J Urol. 2016; 195: 1340-1347
- Ablation of small renal masses: practice patterns at academic institutions in the United States.J Endourol. 2013; 27: 158-161
- Follow-up for clinically localized renal neoplasms: AUA guideline.J Urol. 2013; 190: 407-416
- Renal mass biopsy and thermal ablation: should biopsy be performed before or during the ablation procedure?.Abdom Radiol. 2017; 42: 1773-1780
- Comparison of renal cell carcinoma surveillance Guidelines: competing trade-offs.J Urol. 2016; 195: 1664-1670
- Significant variability in 10-year cumulative radiation exposure incurred on different surveillance regimens after surgery for pT1 renal cancers: yet another reason to standardize protocols?.BJU Int. 2013; 111: 891-896
- Growth kinetics of small renal masses on active surveillance: variability and results from the DISSRM registry.J Urol. 2018; 199: 641-648
- Five-year analysis of a multi-institutional prospective clinical trial of delayed intervention and surveillance for small renal masses: the DISSRM registry.Eur Urol. 2015; 68: 408-415
- Renal mass and localized renal cancer: AUA guideline.J Urol. 2017; 198: 520-529
- Focal ablation therapy for renal cancer in the era of active surveillance and minimally invasive partial nephrectomy.Nat Rev Urol. 2017; 14: 669-682
Article info
Publication history
Published online: August 26, 2019
Accepted:
August 14,
2019
Received:
June 5,
2019
Footnotes
Funding: None.
Identification
Copyright
© 2019 Published by Elsevier Inc.
