To evaluate survival of patients with localized T1a clear cell renal cell carcinoma (ccRCC) who received cryosurgery or thermal ablation compared to deferred therapy.
We included 733 patients with histopathologically confirmed localized T1a ccRCC who either received cryosurgery (n = 315) or thermal ablation (n = 155), as well as patients who deferred therapy (n = 263) from the 2000-2013 Surveillance, Epidemiology, and End Results Program urinary cancer file. Cox proportional hazard models were used to compare cancer-specific survival (CSS) across subgroups. Sensitivity analyses were conducted to assess potential unmeasured confounding by comorbidities.
Patients treated with cryosurgery and thermal ablation had a statistically significant CSS benefit compared to those who deferred therapy (cryosurgery HR 0.25, 95% CI 0.14-0.45, p < 0.001; thermal ablation HR 0.27, 95% CI 0.13-0.55, p < 0.001, after adjustment for age at diagnosis, tumor grade, and size). There was no significant difference in CSS comparing cryosurgery to thermal ablation (HR 1.03, 95% CI 0.45-2.3, p = 0.95, after adjustment for age at diagnosis, tumor grade, and size). These results proved robust upon sensitivity analyses: After adjustment for comorbidities with varying prevalence assumptions, the corrected hazard ratio (cHR) of cryosurgery versus deferred therapy ranged between HR 0.09 and 0.68.
Local ablative techniques provide relevant survival benefit and are preferable alternatives over deferred therapy. Cryosurgery and thermal ablation yield comparable outcomes.
2b according to the Oxford Centre for evidence-based medicine levels of evidence.
Cardiovascular and interventional radiology. 2017 Oct 26 [Epub ahead of print]
Annemarie Uhlig, Oliver Hahn, Arne Strauss, Joachim Lotz, Lutz Trojan, René Müller-Wille, Johannes Uhlig
Department of Urology, University Medical Center Goettingen, Robert-Koch-Strasse 40, 37075, Goettingen, Germany. ., Department of Urology, University Medical Center Goettingen, Robert-Koch-Strasse 40, 37075, Goettingen, Germany., Department of Interventional and Diagnostic Radiology, University Medical Center Goettingen, Robert-Koch-Strasse 40, 37075, Goettingen, Germany.