Thermal Ablation vs Nephrectomy for Renal Cell Carcinoma

A recent study comparing outcomes for thermal ablation versus nephrectomy for renal cell carcinoma found that thermal ablation provided superior outcomes. The study was published in Radiology.

The study was undertaken with the goal of comparing several factors in patients treated with nephrectomy or thermal ablation, including demographic differences, perioperative outcomes, and mortality. Using the National Cancer Database, the authors identified 4,817 of 56,065 patients (8.6%) who underwent thermal ablation and 51,248 of 56,065 patients (91.4%) who were treated with nephrectomy. All patients underwent their procedures between 2004 and 2013, and all patients had biopsy-proven T1aN0M0 renal cell carcinoma.

A propensity score-matched cohort using χ2 tests, Cox proportional hazards models, and Renyi family tests was used to evaluate unplanned hospital readmission, mean hospital stay, 30- and 90-day postoperative mortality, and survival.

Results showed that older patients with more comorbidities tended to receive thermal ablation. Other factors linked with higher likelihood of being treated with thermal ablation were male sex, white race, nonprivate insurance, therapy at academic centers, and south Atlantic state urban residence with lower income and education.

The researchers found that  perioperative outcomes were superior for thermal ablation after matching. These outcomes included unplanned hospital readmission (2% vs 3.3%), mean hospital stay (1.3 days vs 4.3 days), and 30- and 90-day postoperative mortality (0% vs 0.9%, and 0% vs 1.4%, respectively).

Patients older than 65 years had similar rates of survival for thermal ablation and nephrectomy, as did all patients during the first year following the procedure.

“Thermal ablation for RCC varied by national region and with multiple clinical and nonclinical demographic factors. Thermal ablation demonstrates superior perioperative outcomes with short mean hospital stay, low unplanned hospital readmission, and 30- and 90-day mortality. In selected patients, thermal ablation survival may be comparable to nephrectomy,” the researchers concluded.

—Lauren LeBano

Reference

Uhlig J, Kokabi N, Xing M, Kim HS. Ablation versus resection for stage 1a renal cell carcinoma: national variation in clinical management and selected outcomes. Radiology. 2018 Jul 3:172960. doi: 10.1148/radiol.2018172960. [Epub ahead of print]