Introduction Institutional studies suggested that tumor size (TS) might be an independent predictor of recurrence after local tumor ablation (LTA). However, limited data exist to ascertain whether larger TS may also predispose to worse cancer-specific mortality (CSM).
Materials and methods Patients treated with LTA for T1a non-metastatic RCC were identified within the SEER database (2004-2015). Estimated annual proportion change methodology (EAPC), cumulative incidence plots and multivariable competing risks (CCR) regression models before and after 1:1 ratio propensity score (PS) adjustment were used to compare LTA for TS≤30mm vs TS>30 mm. A comparison of cryosurgery vs thermal ablation according to TS was also performed. Results Of 3,946 LTA patients, 2,974 (75.3%) patients harbored TS≤30mm vs 972 (24.7%) harbored TS>30mm. The latter were significantly older (median age 67 vs 71 years, p<0.001), compared to TS≤30 mm. No differences were recorded in annual rates over time. In unmatched CRR models, after adjustment for other-cause mortality (OCM), LTA for TS>30mm showed worse 5-year CSM (HR 2.3, p<0.001), relative to TS≤30 mm. In PS and OCM-adjusted CRR models, LTA for TS>30mm still showed worse 5-year CSM (HR 2.86, p<0.001), relative to TS≤30 mm. Thermal ablation was associated with higher 5-year CSM, compared to cryosurgery (7.6 vs 3.9%, p=0.02), but only when TS was >30 mm. Conclusions TS>30 mm is an independent predictor of higher 5-years CSM rates in patients treated with LTA, even after adjustment for OCM. In consequence, when LTA is considered it ideally should be performed for TS≤30 mm.
Journal of endourology. 2019 Apr 16 [Epub ahead of print]
Carlotta Palumbo, Sarah-Jeanne Cyr, Elio Mazzone, Francesco Alessandro Mistretta, Sophie Knipper, Angela Pecoraro, Zhe Tian, Shahrokh F Shariat, Fred Saad, Claudio Simeone, Alberto Briganti, Anil Kapoor, Alessandro Antonelli, Pierre I Karakiewicz
Spedali Civili Hospital, University of Brescia, Department of Urology , Piazzale Spedali Civili 1 , Brescia, Italy , 25123 ; ., Montreal, Quebec, Canada ; ., Ospedale San Raffaele, 9372 , Via Olgettina , Milano, Italy , 20132 ; ., Istituto Europeo di Oncologia, 9290, Urology , Via Ripamonti 435 , Milano, Italy , 20141., Hamburg, Germany ; ., Azienda Ospedaliero Universitaria San Luigi Gonzaga, Urology Orbassano, IT, Orbassano - Turin, Italy ; ., Montreal, Canada ; ., 1330 first avenue, 1024ny, New York, United States , 10021., Centre de recherche du CHUM, 177460, Montreal, Quebec, Canada ; ., Spedali Civili Hospital, University of Brescia, Department of Urology, Brescia, Italy ; ., Milan, Italy ; ., Hamilton, Canada ; ., Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia, 18515, Dept. of Urology , Piazzale Spedali Civili 1 , Brescia , Brescia, Outside U.S./Canada, Italy , 25125 ; ., University of Montreal Health Center, Cancer Prognostics and Health Outcomes Unit, Montreal, Quebec, Canada.
PubMed http://www.ncbi.nlm.nih.gov/pubmed/30990074
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