To compare the survival outcomes of local ablation (LA) and partial nephrectomy (PN) for T1N0M0 renal cell carcinoma (RCC).
We identified 38,155 T1N0M0 RCC patients treated with PN or LA in 2004-2016 from the retrospective Surveillance, Epidemiology, and End Results databases. Among them, there were 4656 LA and 33,499 PN. A Cox proportional hazards regression model, cause-specific Cox regression and Fine and Gray sub-distribution hazard ratio (sHR) with inverse probability of treatment weighting (IPTW) adjusting was utilized to compare the effects of LA vs PN on all-, RCC-, and non-RCC-caused mortality.
Within the IPTW analysis, patients who underwent PN experienced a better overall survival (OS) (HR, 1.56; 95% CI, 1.40-1.74; P < .001) and cancer-specific survival (CSS) (HR, 2.21; 95% CI, 1.62-2.98; P < .001) than LA patients. In the subgroup of patients >85 years (HR, 1.14; 95% CI, 0.73-1.79, P = .577), chromophobe RCC (HR, 1.68; 95% CI, 0.94-3.00, P = .078), and tumor size <2 cm (HR, 1.21; 95% CI, 0.95-1.53, P = .126), the OS showed no significant difference between LA and PN. No significant difference in CSS between LA and PN was observed in the subgroup of chromophobe RCC (HR, 0.34; 95% CI, 0.03-3.97, P = .389), and tumor size <2 cm (HR, 1.83; 95% CI, 0.92-3.64, P = .084). For patients >85 years (sHR, 0.89; 95% CI, 0.52-1.27, P = .520) and tumor size <2 cm (sHR, 1.14; 95% CI, 0.94-1.38, P = .200), the non-RCC-specific mortality was not significantly different in PN and LA cohorts, however, for the chromophobe RCC, the LA showed a worse non-RCC mortality than PN (HR, 1.72; 95% CI, 1.06-2.79, P = .028).
PN showed a better prognosis than LA in T1N0M0 RCC treatment, but LA and PN showed a comparable OS in elderly patients (>85), small RCC (<2 cm) and chromophobe RCC.
Cancer medicine. 2020 Sep 05 [Epub ahead of print]
Lei Shi, Yan He, Chang Liu, Xiaoyuan Qian, Zhixian Wang
Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China., Department of Urology, The First Affiliated Hospital of Xinxiang Medical University, Xinxiang Medical University, Xinxiang, China., Department of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.