Partial nephrectomy vs cryoablation for T1a renal cell carcinoma: A comparison of survival benefit stratified by tumour size |
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| Institution: | 1. Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY;2. Department of Urology, Wake Forest School of Medicine, Winston-Salem, NC;3. Robotic Urologic Surgery, OhioHealth Dublin Methodist Hospital, Columbus, OH;4. Department of Urology, Temple University School of Medicine, Philadelphia, PA;5. Division of Urology, Columbia University at Mount Sinai, Miami Beach, FL;6. Swedish Urology Group, Seattle, WA;1. Albert Einstein College of Medicine, Bronx, NY;2. Montefiore Medical Center, Medical Arts Pavilion, Bronx, NY;1. Minimally Invasive Urology Institute, The Miriam Hospital, Providence, RI;2. Columbia University Division of Urology, Mount Sinai Medical Center, Miami Beach, FL;3. Lifespan Oncology Clinical Research, The Miriam Hospital, Providence, RI;4. Warren Alpert Medical School of Brown University, Providence, RI;5. Division of Urology, Rhode Island Hospital and The Miriam Hospital, Providence, RI;6. Department of Pathology and Laboratory Medicine, The Miriam Hospital, Providence, RI;7. Department of Hematology/Oncology, The Miriam Hospital, Providence, RI;8. Department of Urology, Mayo Clinic, Rochester, MN;9. Divison of Urologic Surgery, Beth Israel Deaconess Medical Center, Boston, MA |
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| Abstract: | ObjectiveWe compared the impact on survival outcomes of partial nephrectomy (PN) and cryoablation (CA) for patients diagnosed with T1a renal cell carcinoma (RCC).Patients and MethodsAmong patients diagnosed between 2004 and 2014 in the Surveillance, Epidemiology and End Results program, we identified histologically confirmed T1aN0M0 RCC treated with PN (n = 17644) or CA (n = 868). Propensity score matching (PSM) was performed. Kaplan-Meier method, Cox proportional hazards model were used to calculate cancer specific mortality (CSM) and overall mortality (OM) in the unmatched and matched cohort, and in subgroups based on tumour size (< 2 cm, 2-3 cm, 3-4 cm). Sensitivity analyses were performed.ResultsA total of 18512 patients were identified: PN (93.88%) and CA (6.12%). In the propensity-score matched cohort, for tumours ≤ 2 cm, the CA and PN groups had similar CSM (HR: 1.41, 95% CI: 0.32–6.31, p = 0.65) and OM (HR 0.97, 95%CI: 0.47–2.01, p = 0.93). For tumours 2-3 cm, CA was associated with similar CSM (HR 1.64, 95%CI: 0.67–4.03, p = 0.28) but higher OM (HR 2.05, 95%CI: 1.35–3.11, p < 0.001), compared with PN. For tumours 3-4 cm, CA was associated with increased CSM (HR: 3.76, 95% CI: 1.62–8.69, p = 0.002) and OM (HR 2.17, 95%CI: 1.48–3.18, p < 0.001).ConclusionFor RCC ≤ 2 cm, PN and CA are equal in survival outcomes. For RCC 2-4 cm, PN may have a possible advantage over CA. |
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| Keywords: | Cryoablation Partial nephrectomy Renal cell carcinoma Propensity score Mortality |
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