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Microwave ablation of the T1a small renal mass: expanding beyond 3 cm

  • Kidneys, Ureters, Bladder, Retroperitoneum
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

Purpose

To compare the oncological and renal function outcomes for patients receiving microwave ablation (MWA) in tumors < 3 and 3–4 cm.

Methods

Retrospective analysis of a prospectively maintained database identified patients with < 3 or 3–4 cm renal cancers undergoing MWA. Radiographic follow-up occurred at approximately 6 months post-procedure and annually thereafter. Serum creatinine and estimated glomerular filtration rate (eGFR) were calculated before and 6-months post-MWA. Local recurrence-free survival (LRFS) was estimated using the Kaplan–Meier method. Tumor size was evaluated as a prognostic factor using Cox proportional-hazards regression. Predictors for change in eGFR and chronic kidney disease (CKD) stage were modeled using linear and ordinal logistic regression.

Results

A total of 126 patients fit the inclusion criteria. Overall recurrences were 2/62 (3.2%) and 6/64 (9.4%) for < 3 versus 3–4 cm. Both recurrences in the < 3 cm group were local, 4/6 in the 3–4 cm group were local and 2/6 were metastatic without local progression. For < 3 versus 3–4 cm, cumulative LRFS at 36 months was 94.6% versus 91.4%. Tumor size was not a significant prognostic factor for LRFS. Renal function did not change significantly after MWA. Patient comorbidities and RENAL nephrometry score significantly affected change in CKD.

Conclusion

With comparable oncological outcomes, complication rates, and renal function preservation, MWA is a promising management strategy for renal masses of 3–4 cm in select patients. Our findings suggest that current AUA guidelines, which recommend thermal ablation for tumors < 3 cm, may need review to include T1a tumors for MWA, regardless of size.

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Abbreviations

cT1a:

Clinical T1a

MWA:

Microwave ablation

eGFR:

Estimated glomerular filtration rate

CKD:

Chronic kidney disease

LRFS:

Local recurrence-free survival

SRM:

Small renal mass

PN:

Partial nephrectomy

RFA:

Radiofrequency ablation

CA:

Cryoablation

CT:

Computed tomography

HR:

Hazard ratio

US:

Ultrasound

MRI:

Magnetic resonance imaging

CCI:

Charlson Comorbidity Index

CKD-EPI:

Chronic Kidney Disease Epidemiology Collaboration

IQR:

Interquartile range

AUA:

American Urological Association

References

  1. Capitanio U, Bensalah K, Bex A, et al. Epidemiology of Renal Cell Carcinoma. Eur Urol. 2019;75(1):74-84. doi:https://doi.org/10.1016/j.eururo.2018.08.036

    Article  PubMed  Google Scholar 

  2. Acosta Ruiz V, Ladjevardi S, Brekkan E, et al. Periprocedural outcome after laparoscopic partial nephrectomy versus radiofrequency ablation for T1 renal tumors: a modified R.E.N.A.L nephrometry score adjusted comparison. Acta Radiol. 2019;60(2):260–268. doi:https://doi.org/10.1177/0284185118780891

  3. Campbell SC, Clark PE, Chang SS, Karam JA, Souter L, Uzzo RG. Renal Mass and Localized Renal Cancer: Evaluation, Management, and Follow-Up: AUA Guideline: Part I. J Urol. 2021;206(2):199-208. doi:https://doi.org/10.1097/JU.0000000000001911

    Article  PubMed  Google Scholar 

  4. Martin J, Athreya S. Meta-analysis of cryoablation versus microwave ablation for small renal masses: is there a difference in outcome? Diagn Interv Radiol. Published online October 1, 2013. doi:https://doi.org/10.5152/dir.2013.13070

  5. Wells SA, Wheeler KM, Mithqal A, Patel MS, Brace CL, Schenkman NS. Percutaneous microwave ablation of T1a and T1b renal cell carcinoma: short-term efficacy and complications with emphasis on tumor complexity and single session treatment. Abdom Radiol. 2016;41(6):1203-1211. doi:https://doi.org/10.1007/s00261-016-0776-x

    Article  Google Scholar 

  6. Klapperich ME, Abel EJ, Ziemlewicz TJ, et al. Effect of Tumor Complexity and Technique on Efficacy and Complications after Percutaneous Microwave Ablation of Stage T1a Renal Cell Carcinoma: A Single-Center, Retrospective Study. Radiology. 2017;284(1):272-280. doi:https://doi.org/10.1148/radiol.2016160592

    Article  PubMed  Google Scholar 

  7. Mershon JP, Tuong MN, Schenkman NS. Thermal ablation of the small renal mass: a critical analysis of current literature. Minerva Urol Nefrol. 2020;72(2). doi:https://doi.org/10.23736/S0393-2249.19.03572-0

  8. Charlson M, Szatrowski TP, Peterson J, Gold J. Validation of a combined comorbidity index. J Clin Epidemiol. 1994;47(11):1245-1251. doi:https://doi.org/10.1016/0895-4356(94)90129-5

    Article  CAS  PubMed  Google Scholar 

  9. Canter D, Kutikov A, Manley B, et al. Utility of the R.E.N.A.L. Nephrometry Scoring System in Objectifying Treatment Decision-making of the Enhancing Renal Mass. Urology. 2011;78(5):1089–1094. doi:https://doi.org/10.1016/j.urology.2011.04.035

  10. Dindo D, Demartines N, Clavien PA. Classification of Surgical Complications: A New Proposal With Evaluation in a Cohort of 6336 Patients and Results of a Survey. Ann Surg. 2004;240(2):205-213. doi:https://doi.org/10.1097/01.sla.0000133083.54934.ae

    Article  PubMed  PubMed Central  Google Scholar 

  11. Efthymiou E, Siatelis A, Liakouras C, et al. Computed Tomography-Guided Percutaneous Microwave Ablation for Renal Cell Carcinoma: Impact of Tumor Size on the Progression Survival Rates. Diagnostics. 2021;11(9):1618. doi:https://doi.org/10.3390/diagnostics11091618

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Acosta Ruiz V, Dahlman P, Brekkan E, Lönnemark M, Magnusson A. Microwave ablation of 105 T1 renal tumors: technique efficacy with a mean follow-up of two years. Acta Radiol. Published online September 10, 2020:028418512095628. doi:https://doi.org/10.1177/0284185120956283

  13. Umbreit EC, Shimko MS, Childs MA, et al. Metastatic potential of a renal mass according to original tumour size at presentation: METASTATIC POTENTIAL BASED ON RENAL TUMOUR SIZE. BJU Int. 2012;109(2):190-194. doi:https://doi.org/10.1111/j.1464-410X.2011.10184.x

    Article  PubMed  Google Scholar 

  14. Thompson RH, Hill JR, Babayev Y, et al. Metastatic Renal Cell Carcinoma Risk According to Tumor Size. J Urol. 2009;182(1):41-45. doi:https://doi.org/10.1016/j.juro.2009.02.128

    Article  PubMed  PubMed Central  Google Scholar 

  15. Kunkle DA, Crispen PL, Li T, Uzzo RG. Tumor Size Predicts Synchronous Metastatic Renal Cell Carcinoma: Implications for Surveillance of Small Renal Masses. J Urol. 2007;177(5):1692-1697. doi:https://doi.org/10.1016/j.juro.2007.01.029

    Article  PubMed  Google Scholar 

  16. Yu J, Liang P, Yu X ling, et al. US-guided Percutaneous Microwave Ablation of Renal Cell Carcinoma: Intermediate-term Results. Radiology. 2012;263(3):900–908. doi:https://doi.org/10.1148/radiol.12111209

  17. Gao Y, Liang P, Yu X, et al. Microwave treatment of renal cell carcinoma adjacent to renal sinus. Eur J Radiol. 2016;85(11):2083-2089. doi:https://doi.org/10.1016/j.ejrad.2016.09.018

    Article  PubMed  Google Scholar 

  18. Shapiro DD, Wells SA, Best SL, et al. Comparing Outcomes for Patients with Clinical T1b Renal Cell Carcinoma Treated With Either Percutaneous Microwave Ablation or Surgery. Urology. 2020;135:88-94. doi:https://doi.org/10.1016/j.urology.2019.09.024

    Article  PubMed  Google Scholar 

  19. Guo J, Arellano RS. Percutaneous Microwave Ablation of Stage T1b Renal Cell Carcinoma: Short-Term Assessment of Technical Feasibility, Short-Term Oncologic Outcomes, and Safety. J Endourol. 2020;34(10):1021-1027. doi:https://doi.org/10.1089/end.2020.0382

    Article  PubMed  Google Scholar 

  20. Wah TM, Irving HC, Gregory W, Cartledge J, Joyce AD, Selby PJ. Radiofrequency ablation (RFA) of renal cell carcinoma (RCC): experience in 200 tumours: RFA for RCC. BJU Int. 2014;113(3):416-428. doi:https://doi.org/10.1111/bju.12349

    Article  PubMed  Google Scholar 

  21. Schmit GD, Thompson RH, Kurup AN, et al. Usefulness of R.E.N.A.L. Nephrometry Scoring System for Predicting Outcomes and Complications of Percutaneous Ablation of 751 Renal Tumors. J Urol. 2013;189(1):30–35. doi:https://doi.org/10.1016/j.juro.2012.08.180

  22. Kang SK, Huang WC, Skolnik EY, Gervais DA, Braithwaite RS, Pandharipande PV. Tumor Anatomy Scoring and Renal Function for Nephron-Sparing Treatment Selection in Patients With Small Renal Masses: A Microsimulation-Based Decision Analysis. Am J Roentgenol. 2016;207(2):344-353. doi:https://doi.org/10.2214/AJR.15.15823

    Article  Google Scholar 

  23. Santos Arrontes D, Fernández Aceñero MJ, García González JI, Martín Muñoz M, Paniagua Andrés P. Survival Analysis of Clear Cell Renal Carcinoma According to the Charlson Comorbidity Index. J Urol. 2008;179(3):857-861. doi:https://doi.org/10.1016/j.juro.2007.10.048

    Article  PubMed  Google Scholar 

  24. Audenet F, Audouin M, Drouin SJ, et al. Charlson score as a single pertinent criterion to select candidates for active surveillance among patients with small renal masses. World J Urol. 2014;32(2):513-518. doi:https://doi.org/10.1007/s00345-013-1131-2

    Article  PubMed  Google Scholar 

  25. Choi SH, Kim JW, Kim JH, Kim KW. Efficacy and Safety of Microwave Ablation for Malignant Renal Tumors: An Updated Systematic Review and Meta-Analysis of the Literature Since 2012. Korean J Radiol. 2018;19(5):938. doi:https://doi.org/10.3348/kjr.2018.19.5.938

    Article  PubMed  PubMed Central  Google Scholar 

  26. Dong X, Li X, Yu J, Yu M an, Yu X, Liang P. Complications of ultrasound-guided percutaneous microwave ablation of renal cell carcinoma. OncoTargets Ther. 2016;Volume 9:5903–5909. doi:https://doi.org/10.2147/OTT.S109783

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Funding

No funds, grants, or other support was received. The authors have no relevant financial or non-financial interests to disclose.

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Author notes

  1. Jessica Qiu, Christopher Ballantyne contributed equally to this work.

Authors and Affiliations

  1. University of Virginia School of Medicine, 1300 Jefferson Park Avenue, P.O. Box 800717, Charlottesville, VA, 22908-0717, USA

    Jessica Qiu, Moritz Lange, John Morgan, J. Patrick Mershon, Iman Richie & Anthony DeNovio

  2. Department of Urology, University of Virginia, Charlottesville, VA, USA

    Christopher Ballantyne, Clint Yeaman, Tracey L. Krupski, Noah Schenkman & Jennifer M. Lobo

  3. Department of Urology, Lahey Hospital & Medical Center, Burlington, MA, USA

    Matthew B. Clements

  4. Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, VA, USA

    Jennifer M. Lobo

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  1. Jessica Qiu
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Correspondence to Jennifer M. Lobo.

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Qiu, J., Ballantyne, C., Yeaman, C. et al. Microwave ablation of the T1a small renal mass: expanding beyond 3 cm. Abdom Radiol 48, 2695–2704 (2023). https://doi.org/10.1007/s00261-023-03935-9

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  • DOI: https://doi.org/10.1007/s00261-023-03935-9

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