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Comparing Outcomes for Patients with Clinical T1b Renal Cell Carcinoma Treated With Either Percutaneous Microwave Ablation or Surgery.
- Source :
-
Urology [Urology] 2020 Jan; Vol. 135, pp. 88-94. Date of Electronic Publication: 2019 Oct 01. - Publication Year :
- 2020
-
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).<br />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.<br />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).<br />Conclusion: Microwave ablation is a feasible alternative to surgery in select comorbid patients with clinical T1b renal cell carcinoma.<br /> (Copyright © 2019. Published by Elsevier Inc.)
- Subjects :
- Aged
Carcinoma, Renal Cell mortality
Disease-Free Survival
Feasibility Studies
Female
Follow-Up Studies
Glomerular Filtration Rate
Humans
Kaplan-Meier Estimate
Kidney Neoplasms mortality
Male
Microwaves therapeutic use
Middle Aged
Neoplasm Recurrence, Local epidemiology
Neoplasm Recurrence, Local prevention & control
Neoplasm Staging
Nephrectomy methods
Postoperative Complications etiology
Radiofrequency Ablation methods
Reoperation statistics & numerical data
Carcinoma, Renal Cell surgery
Kidney Neoplasms surgery
Neoplasm Recurrence, Local surgery
Nephrectomy adverse effects
Postoperative Complications epidemiology
Radiofrequency Ablation adverse effects
Subjects
Details
- Language :
- English
- ISSN :
- 1527-9995
- Volume :
- 135
- Database :
- MEDLINE
- Journal :
- Urology
- Publication Type :
- Academic Journal
- Accession number :
- 31585198
- Full Text :
- https://doi.org/10.1016/j.urology.2019.09.024