Trends in the utilization of ablative therapy are unknown for the treatment of small renal masses. Our goal is to utilize the National Cancer Database to both assess utilization of ablative therapies and long-term survival.
The National Cancer Database captures 70% of all cancer cases in the United States and was queried between 1998 and 2012 for renal cell carcinomas that were treated with ablative therapy, partial nephrectomy, or radical nephrectomy. The analysis was limited to clinical stage T1a. Propensity score matching was used in 1:1 fashion. Kaplan-Meier survival analysis and a Cox proportional hazards model were used to compare overall survival for cryotherapy and partial nephrectomy.
A total of 119,240 cases of clinical stage T1a renal masses were treated between 1998 and 2012. Cryotherapy peaked at 927 (9.1%) cases in 2010 and had 913 (8.4%) in 2012. Partial nephrectomy accounted for 18% of the cases in 1998, but surpassed the utilization of nephrectomy in 2008. By 2012, partial nephrectomy accounted for 6,766 (62%) of renal mass cases. After matching, Kaplan-Meier overall survival was lower for cryotherapy when compared to partial nephrectomy at 24 (94.5% vs. 96.5%), 48 (86.8% vs. 90.9%), and 96 months (66.0% vs. 74.9%). Cryotherapy also had a lower overall survival (HR 1.46, p<0.001) on adjusted analysis.
Cryotherapy for small renal masses plateaued at 9% utilization in 2009. Cryotherapy had a lower overall survival than partial nephrectomy for tumors greater than 2 cm on adjusted analysis, but this result should be used with caution until confirmed in randomized studies.
Journal of endourology. 2019 Feb 27 [Epub ahead of print]
Weston Riley Kitley, Jay Sulek, Chandru P Sundaram, Clinton D Bahler
Indiana University Department of Urology, 372831, Urology, Indianapolis, Indiana, United States ; ., Indiana University Department of Urology, 372831, Urology, Indianapolis, Indiana, United States ; ., Indiana University School of Medicine, Urology , 535 N Barnhill Dr, Suite 420 , Indianapolis, Indiana, United States , 46202 ; ., Indiana University School of Medicine, Urology , 535 N Barnhill Dr , STE 420 , Indianapolis, Indiana, United States , 46202 ; .