Minerva Urologica e Nefrologica 2020 Dec 01

DOI: 10.23736/S0393-2249.20.03983-1

Copyright © 2020 EDIZIONI MINERVA MEDICA

lingua: Inglese

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

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