To compare the overall survival (OS) of patients receiving cryoablation versus heat-based thermal ablation for clinical T1a renal cell carcinoma (RCC) in a large national cohort.
Patients with RCC from 2004 to 2014 who were treated with ablation were identified from the National Cancer Database. OS was estimated with the use of the Kaplan-Meier method and evaluated by means of log-rank test, univariate and multivariate Cox proportional hazard regression, and propensity score-matched analysis.
A total of 3,936 patients who received cryoablation and 2,322 who received heat-based thermal ablation met the inclusion criteria. The mean age was 67 ± 12 year, and the mean size of tumors was 25 ± 8 mm. The 3-, 5-, and 10-year survival rates were, respectively, 91%, 82%, and 62% for cryoablation and 89%, 81%, and 55% for heat-based thermal ablation. After propensity score matching, cryoablation was associated with longer OS compared with heat-based thermal ablation (median 11.3 vs 10.4 years; hazard ratio 1.175, 95% CI 1.03-1.341; P = .016). For patients with tumors ≤2 cm, propensity score-matched analyses demonstrated no significant difference between the 2 treatment groups (P = .772).
Overall, cryoablation may be associated with longer OS compared with heat-based thermal ablation in cT1a RCC. No significant difference in survival rates was observed between the 2 treatments for patients with tumor sizes ≤2 cm. Owing to the inherent limitations of this study, further study with details on technology, local outcome, and complications is needed.
Journal of vascular and interventional radiology : JVIR. 2019 Jun 05 [Epub]
Jing Wu, Joshua Chang, Harrison X Bai, Chang Su, Paul J Zhang, Giorgos Karakousis, Shilpa Reddy, Stephen Hunt, Michael C Soulen, S William Stavropoulos, Zishu Zhang
Department of Radiology, Second Xiangya Hospital, Central South University, No 139 Middle Renmin Road, Changsha, Hunan, 410011, People's Republic of China., Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania., Yale School of Medicine, New Haven, Connecticut., Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania., Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania., Department of Radiology, Second Xiangya Hospital, Central South University, No 139 Middle Renmin Road, Changsha, Hunan, 410011, People's Republic of China. Electronic address: .