Cryoablation Predisposes to Higher Cancer Specific Mortality Relative to Partial Nephrectomy in Patients with Nonmetastatic pT1b Kidney Cancer

No AccessJournal of UrologyAdult Urology1 Dec 2019Cryoablation Predisposes to Higher Cancer Specific Mortality Relative to Partial Nephrectomy in Patients with Nonmetastatic pT1b Kidney CancerThis article is commented on by the following:Editorial CommentEditorial Comment Angela Pecoraro, Carlotta Palumbo, Sophie Knipper, Francesco A. Mistretta, Zhe Tian, Shahrokh F. Shariat, Fred Saad, Alberto Briganti, Cristian Fiori, Francesco Porpiglia, and Pierre I. Karakiewicz Angela PecoraroAngela Pecoraro *Correspondence: Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Regione Gonzole, 10, Orbassano, Turin, Piedmont , 10043, Italy telephone: +393474670691; FAX: +39 011 9026244; E-mail Address: [email protected] Cancer Prognostics and Health Outcomes Unit, University of Montreal Hospital Center, Montreal, Quebec, Canada Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano , Carlotta PalumboCarlotta Palumbo *Correspondence: Department of Urology, Spedali Civili Hospital of Brescia, University of Brescia, Brescia, 25123, Italy E-mail Address: [email protected] Cancer Prognostics and Health Outcomes Unit, University of Montreal Hospital Center, Montreal, Quebec, Canada Urology Unit, ASST Spedali Civili of Brescia, Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia , Sophie KnipperSophie Knipper Cancer Prognostics and Health Outcomes Unit, University of Montreal Hospital Center, Montreal, Quebec, Canada Martini-Klinik, University Medical Center Hamburg-Eppendorf, Hamburg, Germany , Francesco A. MistrettaFrancesco A. Mistretta Cancer Prognostics and Health Outcomes Unit, University of Montreal Hospital Center, Montreal, Quebec, Canada Department of Urology, European Institute of Oncology, Milan, Italy , Zhe TianZhe Tian Cancer Prognostics and Health Outcomes Unit, University of Montreal Hospital Center, Montreal, Quebec, Canada , Shahrokh F. ShariatShahrokh F. Shariat Department of Urology, Medical University of Vienna, Vienna, Austria , Fred SaadFred Saad Cancer Prognostics and Health Outcomes Unit, University of Montreal Hospital Center, Montreal, Quebec, Canada Division of Urology, University of Montreal Hospital Center, Montreal, Quebec, Canada , Alberto BrigantiAlberto Briganti Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS San Raffaele Scientific Institute and Vita-Salute San Raffaele University, Milan, Italy , Cristian FioriCristian Fiori Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano , Francesco PorpigliaFrancesco Porpiglia Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano , and Pierre I. KarakiewiczPierre I. Karakiewicz Cancer Prognostics and Health Outcomes Unit, University of Montreal Hospital Center, Montreal, Quebec, Canada Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS San Raffaele Scientific Institute and Vita-Salute San Raffaele University, Milan, Italy View All Author Informationhttps://doi.org/10.1097/JU.0000000000000460AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Cryoablation is done in select patients with pT1b nonmetastatic renal cell carcinoma without convincing proof of efficacy. Our aim was to test for differences in the cancer specific mortality rate for cryoablation and partial nephrectomy in T1b nonmetastatic renal cell carcinoma cases. Materials and Methods: In the 2004 to 2015 SEER (Surveillance, Epidemiology, and End Results) database we identified 5,763 patients with a T1b tumor treated with cryoablation or partial nephrectomy. Modeling relied on multivariable logistic regression models predicting cryoablation vs partial nephrectomy. After 1:2 ratio propensity score matching between patients treated with cryoablation vs partial nephrectomy we used cumulative incidence plot and competing risks regression to test differences in cancer specific mortality and other cause mortality rates. Results: Relative to the 5,521 patients who underwent partial nephrectomy the 242 treated with cryoablation were older, had smaller tumors and more frequently harbored unclassified renal cell carcinoma of low or unknown grade. Median followup was 38 months. In multivariable logistic regression models predicting cryoablation vs partial nephrectomy more advanced patient age was an independent predictor (OR 1.03; p=0.007). After propensity score matching and other cause mortality adjustment the 5-year cancer specific mortality rate was 2.5-fold higher after cryoablation than after partial nephrectomy (p=0.03). Conversely after propensity score matching and cancer specific mortality adjustment the 5-year other cause mortality rate was similar to that of partial nephrectomy after cryoablation (HR 1.45, p=0.12). The major limitation of this study was the lack of recurrence and metastatic progression data. Conclusions: The current findings demonstrated a 2.5-fold increase in cancer specific mortality when cryoablation was performed in patients with pT1b renal cell carcinoma. This observation should be interpreted as a contraindication to cryoablation outside clinical trials or institutional protocols. References 1. : Cryoablation versus partial nephrectomy for clinical T1b renal tumors: a matched group comparative analysis. Eur Urol 2017; 71: 111. Google Scholar 2. : Comparison of partial nephrectomy and percutaneous ablation for cT1 renal masses. Eur Urol 2015; 67: 252. Google Scholar 3. : Radiofrequency ablation versus cryoablation for T1b renal cell carcinoma: a multi-center study. Jpn J Radiol 2018; 36: 551. Google Scholar 4. : Safety considerations and local tumor control following percutaneous image-guided cryoablation of T1b renal tumors. Cardiovasc Intervent Radiol 2018; 41: 449. Google Scholar 5. : Percutaneous cryoablation of stage T1b renal cell carcinoma: technique considerations, safety, and local tumor control. J Vasc Interv Radiol 2015; 26: 792. Google Scholar 6. : Laparoscopic radiofrequency ablation with intraoperative contrast-enhanced ultrasonography for T1bN0M0 renal tumors: initial functional and oncologic outcomes. J Endourol 2014; 28: 4. Google Scholar 7. : Long-term oncologic outcomes after radiofrequency ablation for T1 renal cell carcinoma. Eur Urol 2013; 63: 486. Google Scholar 8. : Radiofrequency ablation versus radical nephrectomy: clinical outcomes for stage T1b renal cell carcinoma. Radiology 2014; 270: 292. Google Scholar 9. : Radio frequency ablation versus partial nephrectomy for clinical T1b renal cell carcinoma: long-term clinical and oncologic outcomes. J Urol 2015; 193: 430. Link, Google Scholar 10. : Renal mass and localized renal cancer: AUA guideline. J Urol 2017; 198: 520. Link, Google Scholar 11. : EAU Guidelines on Renal Cell Carcinoma. European Association of Urology 2018. Available at http://uroweb.org/wp-content/uploads/EAU-RCC-Guidelines-2018-large-text.pdf. Accessed November 23, 2018. Google Scholar 12. National Cancer Institute Surveillance, Epidemiology and End Results Program: Overview of the SEER Program. Available at https://seer.cancer.gov/about/overview.html. Accessed January 24, 2019. Google Scholar 13. : An introduction to propensity score methods for reducing the effects of confounding in observational studies. Multivariate Behav Res 2011; 46: 399. Google Scholar 14. : Introduction to the analysis of survival data in the presence of competing risks. Circulation 2016; 133: 601. Google Scholar 15. : Thermal ablation vs surgery for localized kidney cancer: a Surveillance, Epidemiology, and End results (SEER) database analysis. Urology 2011; 78: 93. Google Scholar 16. : Cryoablation or radiofrequency ablation of the small renal mass. Cancer 2008; 113: 2671. Google Scholar 17. : Cryoablation vs radiofrequency ablation for the treatment of renal cell carcinoma: a meta-analysis of case series studies. BJU Int 2012; 110: 510. Google Scholar 18. : Local tumor destruction in renal cell carcinoma—an inpatient population-based study. Urol Oncol Semin Orig Investig 2014; 32: 54.e1. Google Scholar 19. : Evaluation of the charges, safety, and mortality of percutaneous renal thermal ablation using the Nationwide Inpatient Sample. J Vasc Interv Radiol 2015; 26: 342. Google Scholar 20. : Local tumour ablation for localized kidney cancer: practice patterns in Canada. Can Urol Assoc J 2015; 9: 420. Google Scholar The corresponding author certifies that, when applicable, a statement(s) has been included in the manuscript documenting institutional review board, ethics committee or ethical review board study approval; principles of Helsinki Declaration were followed in lieu of formal ethics committee approval; institutional animal care and use committee approval; all human subjects provided written informed consent with guarantees of confidentiality; IRB approved protocol number; animal approved project number. No direct or indirect commercial, personal, academic, political, religious or ethical incentive is associated with publishing this article. © 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited bySmith J (2019) This Month in Adult UrologyJournal of Urology, VOL. 202, NO. 6, (1069-1070), Online publication date: 1-Dec-2019.Related articlesJournal of Urology28 Aug 2019Editorial CommentJournal of Urology28 Aug 2019Editorial Comment Volume 202Issue 6December 2019Page: 1120-1126Supplementary Materials Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.Keywordscryosurgerymortalitynephrectomykidneyrenal cellcarcinomaMetricsAuthor Information Angela Pecoraro Cancer Prognostics and Health Outcomes Unit, University of Montreal Hospital Center, Montreal, Quebec, Canada Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano *Correspondence: Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Regione Gonzole, 10, Orbassano, Turin, Piedmont , 10043, Italy telephone: +393474670691; FAX: +39 011 9026244; E-mail Address: [email protected] Equal study contribution. More articles by this author Carlotta Palumbo Cancer Prognostics and Health Outcomes Unit, University of Montreal Hospital Center, Montreal, Quebec, Canada Urology Unit, ASST Spedali Civili of Brescia, Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia *Correspondence: Department of Urology, Spedali Civili Hospital of Brescia, University of Brescia, Brescia, 25123, Italy E-mail Address: [email protected] Equal study contribution. More articles by this author Sophie Knipper Cancer Prognostics and Health Outcomes Unit, University of Montreal Hospital Center, Montreal, Quebec, Canada Martini-Klinik, University Medical Center Hamburg-Eppendorf, Hamburg, Germany More articles by this author Francesco A. Mistretta Cancer Prognostics and Health Outcomes Unit, University of Montreal Hospital Center, Montreal, Quebec, Canada Department of Urology, European Institute of Oncology, Milan, Italy More articles by this author Zhe Tian Cancer Prognostics and Health Outcomes Unit, University of Montreal Hospital Center, Montreal, Quebec, Canada More articles by this author Shahrokh F. Shariat Department of Urology, Medical University of Vienna, Vienna, Austria More articles by this author Fred Saad Cancer Prognostics and Health Outcomes Unit, University of Montreal Hospital Center, Montreal, Quebec, Canada Division of Urology, University of Montreal Hospital Center, Montreal, Quebec, Canada More articles by this author Alberto Briganti Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS San Raffaele Scientific Institute and Vita-Salute San Raffaele University, Milan, Italy More articles by this author Cristian Fiori Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano More articles by this author Francesco Porpiglia Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano More articles by this author Pierre I. Karakiewicz Cancer Prognostics and Health Outcomes Unit, University of Montreal Hospital Center, Montreal, Quebec, Canada Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS San Raffaele Scientific Institute and Vita-Salute San Raffaele University, Milan, Italy More articles by this author Expand All The corresponding author certifies that, when applicable, a statement(s) has been included in the manuscript documenting institutional review board, ethics committee or ethical review board study approval; principles of Helsinki Declaration were followed in lieu of formal ethics committee approval; institutional animal care and use committee approval; all human subjects provided written informed consent with guarantees of confidentiality; IRB approved protocol number; animal approved project number. No direct or indirect commercial, personal, academic, political, religious or ethical incentive is associated with publishing this article. 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