BACKGROUND: Radiofrequency ablation (RFA) of renal cell carcinoma (RCC) is used to obtain local control of small renal masses.
However, available long-term oncologic outcomes for RFA of RCC are limited by small numbers, short follow-up, and lack of pathologic diagnoses.
OBJECTIVE: To assess the oncologic effectiveness of RFA for the treatment of biopsy-proven RCC.
DESIGN, SETTING, AND PARTICIPANTS: Exclusion criteria included prior RCC or metastatic RCC, familial syndromes, or T2 RCC. We retrospectively reviewed long-term oncologic outcomes for 185 patients with sporadic T1 RCC. Median follow-up was 6.43 yr (interquartile range [IQR]: 5.3-7.7).
OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The chi-square test and Wilcoxon rank-sum tests were used to compare proportions and medians, respectively. Disease-specific survival and overall survival (OS) were calculated using Kaplan-Meier analysis, then stratified by tumor stage, and comparisons were made using log-rank analysis. The 5-yr disease-free survival (DFS) and OS rates are reported. A p value < 0.05 was considered statistically significant.
RESULTS AND LIMITATIONS: Median tumor size was 3cm (IQR: 2.1-3.9cm). Tumor stage was T1a: 143 (77.3%) or T1b: 42 (22.7%). Twenty-four patients (13%) were retreated for residual disease. There were 12 local recurrences (6.5%), 6 recurrences in T1a disease (4.2%) and 6 in T1b disease (14.3%) (p=0.0196). Median time to recurrence was 2.5 yr. Local salvage RFA was performed in six patients, of whom five remain disease free at 3.8-yr median follow-up. Tumor stage was the only significant predictor of DFS on multivariate analysis. At last follow-up, 164 patients (88.6%) were disease free (T1a: n=132 [92.3%]; T1b: n=32 [76.2%]; p=0.0038). OS was similar regardless of stage (p=0.06). Five patients developed metachronous renal tumors (2.7%). Four patients developed extrarenal metastases (2.2%), three of whom died of metastatic RCC (1.6%).
CONCLUSIONS: In poor surgical candidates, RFA results in durable local control and low risk of recurrence in T1a RCC. Higher stage correlates with a decreased disease-free survival. Long-term surveillance is necessary following RFA. Patient selection based on tumor characteristics, comorbid disease, and life expectancy is of paramount importance.
Written by:
Psutka SP, Feldman AS, McDougal WS, McGovern FJ, Mueller P, Gervais DA. Are you the author?
Department of Urology, Massachusetts General Hospital, Boston, MA, USA.
Reference: Eur Urol. 2012 Sep 5. pii: S0302-2838(12)01015-9.
doi: 10.1016/j.eururo.2012.08.062
PubMed Abstract
PMID: 22959191
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