Local Ablation vs Deferred Surgical Therapy for Renal Cell Carcinoma

Patients with localized T1a clear cell renal cell carcinoma (ccRCC) had better survival outcomes when they were treated with local ablative techniques instead of deferring surgical therapy, according to a study published in the Journal of Cardiovascular and Interventional Radiology.

Although partial nephrectomy is the standard of care, patients who are unable to undergo surgery due to frailty or comorbidities are often treated with local tumor ablation techniques. To better understand the survival outcomes for these different treatment strategies, researchers evaluated data from 2000 to 2013 from the Surveillance, Epidemiology, and End Results (SEER) Program cancer registry.

The analysis included 733 patients with histopathologically confirmed localized T1a ccRCC. Of the patients, 315 received cryosurgery, 155 received thermal ablation, and 263 deferred therapy. Cancer-specific survival (CSS) across subgroups was assessed using Cox proportional hazard models, and potential unmeasured confounding by comorbidities was assessed through sensitivity analyses.

After adjustments for age at diagnosis, tumor grade, and size, the results indicated a statistically significant CSS benefit for patients who were treated with cryosurgery or thermal ablation. However, there was no significant difference in CSS when cryosurgery was compared with thermal ablation. Additionally, the results remained robust after sensitivity analyses, the researchers said.

“The survival benefit of local tumor ablation might originate from adequate local tumor control by ablation of malignant cells and adjacent rim of healthy tissue, while preserving renal function,” the study’s authors wrote.

The study was limited by its retrospective approach and results that might not be generalizable to everyone, as the study pool had a high percentage of African American and female patients.

“There is increasing evidence for the benefit of local ablative techniques in localized kidney cancer among patients not willing or unable to undergo nephrectomy. Future studies should investigate these techniques in a randomized trial setting,” the researchers concluded.

Reference

Uhlig A, Hahn O, Strauss A, et al. Treatment for localized t1a clear cell renal cell carcinoma: survival benefit for cryosurgery and thermal ablation compared to deferred therapy. Cardiovasc Intervent Radiol. 2017 Oct 26. doi: 10.1007/s00270-017-1816-9. [Epub ahead of print].