ABSTRACT
Objective
To compare perioperative and oncologic outcomes for patients with clinical T1b renal
cell carcinoma following treatment with microwave ablation (MW), partial nephrectomy
(PN), or radical nephrectomy (RN).
Methods
Comprehensive clinical and pathologic data were collected for nonmetastatic renal
cell carcinoma patients with cT1b tumors following MW, PN, or RN from 2000 to 2018.
Local recurrence-free, metastasis-free, cancer-specific and overall survival were
estimated using Kaplan-Meier method. Prognostic factors for complications and survival
were determined using logistic regression and Cox hazard models, respectively.
Results
A total of 325 patients (40 MW, 74 PN, and 211 RN) were identified. Patients treated
with MW were older with higher Charlson comorbidity indices compared to surgical patients.
Median length of hospitalization was shorter for MW compared to surgical patients
(1 day vs 4 days, P <.0001). Post-treatment estimated glomerular filtration rate decreased by median
4.5% for MW compared to 3.2% for PN (P = .58) and 29% for RN (P <.001). Median follow-up was 34, 35, and 49 months following MW, PN, and RN, respectively.
Estimated 5-year local recurrence-free survival was 94.5% for MW vs 97.9% for PN (P = .34) and 99.2% for RN (P = .02). Two patients recurred after MW and underwent repeat ablation without subsequent
recurrence. No difference in 5-year metastasis-free survival or cancer-specific survival
was found among MW, PN, or RN. Four (10%) MW patients had high-grade complication.
Only prior abdominal surgery predicted high-grade complication (OR 6.29, P = .017).
Conclusion
Microwave ablation is a feasible alternative to surgery in select comorbid patients
with clinical T1b renal cell carcinoma.
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Article info
Publication history
Published online: October 01, 2019
Accepted:
September 23,
2019
Received:
July 31,
2019
Footnotes
Funding: None.
Conflicts of Interest: Shane A Wells: Consultant Ethicon; Timothy J Ziemlewicz: Consultant Neuwave Medical; Meghan G Lubner: Prior grant funding from Ethicon; J Louis Hinshaw: Consultant Neuwave Medical; Fred T Lee, Jr.: Consultant Neuwave Medical; Stephen Y Nakada: Consultant Boston Scientific.
Identification
Copyright
© 2019 Published by Elsevier Inc.
