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Minerva Urologica e Nefrologica 2020 Dec 01

DOI: 10.23736/S0393-2249.20.03983-1

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

Percutaneous tumor ablation versus partial nephrectomy for small renal mass: the impact of histologic variant and tumor size

Lorenzo BIANCHI 1, 2 , Federico MINEO BIANCHI 1, Francesco CHESSA 1, 2, Umberto BARBARESI 1, Carlo CASABLANCA 1, Pietro PIAZZA 1, Angelo MOTTARAN 1, Matteo DROGHETTI 1, Carlo ROVERONI 1, Eleonora BALESTRAZZI 1, Giorgio GENTILE 1, Caterina GAUDIANO 3, Alessandro BERTACCINI 1, 2, Emanuela MARCELLI 4, Angelo PORRECA 5, Bernardino DE CONCILIO 6, Carla SERRA 7, Antonio CELIA 6, Eugenio BRUNOCILLA 1, 2, Riccardo SCHIAVINA 1, 2

1 Department of Urology, Sant' Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy; 2 Department of Specialistic, Diagnostic and Sperimental Medicine (DIMES), University of Bologna, Bologna, Italy; 3 Department of Radiology, University of Bologna, Bologna, Italy; 4 Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Laboratory of Bioengineering, University of Bologna, Bologna, Italy; 5 Department of Urology, Policlinico Abano Terme, Padova, Italy; 6 Department of Urology, San Bassiano Hospital, Bassano del Grappa, Vicenza, Italy; 7 Interventional Ultrasound Unit, Department of Organ Failure and Transplantations, Sant' Orsola-Malpighi Hospital and University of Bologna, Bologna, Italy


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BACKGROUND: To investigate recurrence rates in patients with T1 renal cell carcinoma (RCC) undergone partial nephrectomy (PN), radiofrequency ablation (RFA) or cryoablation (Cryo).
METHODS: We retrospectively evaluated data from 665 (81.4%), 68 (8.3%) and 83 (10.3%) patients who underwent PN, RFA and Cryo, respectively. Kaplan-Meier curves depict recurrence-free survival (RFS) rates in the overall population and after stratifying according to tumor’s histology (namely, clear cell RCC and non-clear RCC) and size (namely < 2 cm and 2-4 cm). Multivariable Cox regression model was used to identify predictors of recurrence. Cumulative-incidence plots evaluated disease recurrence and other causes of mortality (OCM).
RESULTS: Patients referred to PN experienced higher RFS rate compared to those treated with RFA and Cryo at 60-month in the overall population (96.4% vs. 79.4 % vs. 87.8%), in patients with clear cell RCC (93.3% vs 75% vs. 80.4%) and in those with tumor of 2-4 cm (97.3% vs 78% and 84.4%; all p≤0.01). In patients with non-clear cell RCC and with tumor <2cm, PN showed higher RFS rate at 60-month as compared to RFA (97.9% vs 84.4% and 95.1% vs 78.1%, respectively; all p≤0.02). At multi-variate analysis, ablative techniques (RFA [HR=4.03] and Cryo [HR=3.86]) were independent predictors of recurrence (all p<0.03). At competing risks analysis, recurrence rate and OCM were 7.3% and 1.3% vs 25% and 7.2% vs 19.9% and 19.9% for PN, RFA and Cryo, respectively.
CONCLUSIONS: PN and Cryo showed similar RFS rates in patients with non-clear cell RCC and with renal mass < 2cm.


KEY WORDS: Renal cancer; Partial nephrectomy; Radiofrequency ablation; Cryoablation; Recurrence

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