Abstract
Purpose
To retrospectively compare long-term oncologic outcomes of percutaneous computed tomography-guided microwave ablation (MWA) and robot-assisted partial nephrectomy (RAPN) for the treatment of stage 1 (T1a and T1b) renal cell carcinoma (RCC) patients.
Materials and Methods
Institutional database research identified all T1 RCC patients who underwent either MWA or RAPN. Models were adjusted with propensity score matching. Kaplan–Meier log-rank test analyses and Cox proportional hazard regression models were used to compare the oncologic outcomes. Patient and tumor characteristics, technical success as well as oncologic outcomes were evaluated and compared between the 2 groups.
Results
After propensity score matching, a total of 71 patients underwent percutaneous MWA (mean age 70 ± 10 years) and 71 underwent RAPN (mean age 60 ± 9 years). At 8-year follow-up, the estimated survival rates for MWA cohort were 98% (95% confidence interval [CI] 95–100%) for overall survival, 97% (95% CI 93–100%) for recurrence-free survival, and 97% (95% CI 93–100%) for metastasis-free survival. The matched cohort that underwent RAPN exhibited survival rates of 100% (95% CI 100–100%) for overall survival, 98% (95% CI 94–100%) for recurrence-free survival, and 98% (95% CI 94–100%) for metastasis-free survival. After performing log-rank testing, these rates were not significantly different (p values of 0.44, 0.67, and 0.67, respectively).
Conclusion
The results of the present study suggest that both MWA and RAPN are equally effective in terms of oncologic outcome for the treatment of T1 RCC.
Similar content being viewed by others
References
Bukavina L, Bensalah K, Bray F, et al. Epidemiology of renal cell carcinoma: 2022 update. Eur Urol. 2022;82:529–42. https://doi.org/10.1016/j.eururo.2022.08.019.
Du Z, Chen W, Xia Q, et al. Trends and projections of kidney cancer incidence at the global and national levels, 1990–2030: a Bayesian age-period-cohort modeling study. Biomark Res. 2020;8:16. https://doi.org/10.1186/s40364-020-00195-3.
Lavallée LT, Tanguay S, Jewett MA, et al. Surgical management of stage T1 renal tumors in Canadian academic centers. Can Urol Assoc J. 2015;9:99. https://doi.org/10.5489/cuaj.2598.
Sun M, Bianchi M, Trinh Q-D, et al. Comparison of partial vs radical nephrectomy with regard to other-cause mortality in T1 renal cell carcinoma among patients aged ≥75 years with multiple comorbidities. BJU Int. 2013;111:67–73. https://doi.org/10.1111/j.1464-410X.2012.11254.x.
Yanagisawa T, Mori K, Kawada T, et al. Differential efficacy of ablation therapy versus partial nephrectomy between clinical T1a and T1b renal tumors: a systematic review and meta-analysis. Urol Oncol Semin Orig Invest. 2022;40:315–30. https://doi.org/10.1016/j.urolonc.2022.04.002.
NCCN Guidelines Version 1.2024 Kidney Cancer, Robert Mozer et al.
Campbell SC, Clark PE, Chang SS, et al. Renal mass and localized renal cancer: evaluation, management, and follow-up: AUA guideline: part I. J Urol. 2021;206:199–208. https://doi.org/10.1097/JU.0000000000001911.
Finelli A, Ismaila N, Bro B, et al. Management of small renal masses: American society of clinical oncology clinical practice guideline. J Clin Oncol. 2017;35:668–80. https://doi.org/10.1200/JCO.2016.69.9645.
Kutikov A, Uzzo RG. The R.E.N.A.L. nephrometry score: a comprehensive standardized system for quantitating renal tumor size, location and depth. J Urol. 2009;182:844–53. https://doi.org/10.1016/j.juro.2009.05.035.
Puijk RS, Ahmed M, Adam A, et al. Consensus guidelines for the definition of time-to-event end points in image-guided tumor ablation: results of the SIO and DATECAN initiative. Radiology. 2021;301:533–40. https://doi.org/10.1148/radiol.2021203715.
Filippiadis DK, Binkert C, Pellerin O, et al. Cirse quality assurance document and standards for classification of complications: the cirse classification system. Cardiovasc Intervent Radiol. 2017;40:1141–6. https://doi.org/10.1007/s00270-017-1703-4.
Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien-Dindo classification of surgical complications. Ann Surg. 2009;250:187–96. https://doi.org/10.1097/SLA.0b013e3181b13ca2.
Yao XI, Wang X, Speicher PJ, et al. Reporting and guidelines in propensity score analysis: a systematic review of cancer and cancer surgical studies. JNCI J Natl Cancer Inst. 2017. https://doi.org/10.1093/jnci/djw323.
Zhao Q-Y, Luo J-C, Su Y, et al. Propensity score matching with R: conventional methods and new features. Ann Transl Med. 2021;9:812–812.
Rubin DB. Using propensity scores to help design observational studies: application to the tobacco litigation. Health Serv Outcomes Res Methodol. 2001;2:169–88. https://doi.org/10.1023/A:1020363010465.
Weight CJ, Lieser G, Larson BT, et al. Partial nephrectomy is associated with improved overall survival compared to radical nephrectomy in patients with unanticipated benign renal tumours. Eur Urol. 2010;58:293–8. https://doi.org/10.1016/j.eururo.2010.04.033.
Weight CJ, Larson BT, Gao T, et al. Elective partial nephrectomy in patients with clinical T1b renal tumors is associated with improved overall survival. Urology. 2010;76:631–7. https://doi.org/10.1016/j.urology.2009.11.087.
Li L, Zhu J, Shao H, et al. Long-term outcomes of radiofrequency ablation vs. partial nephrectomy for cT1 renal cancer: a meta-analysis and systematic review. Front Surg. 2023. https://doi.org/10.3389/fsurg.2022.1012897.
Morkos J, Porosnicu Rodriguez KA, Zhou A, et al. Percutaneous cryoablation for stage 1 renal cell carcinoma: outcomes from a 10-year prospective study and comparison with matched cohorts from the national cancer database. Radiology. 2020;296:452–9. https://doi.org/10.1148/radiol.2020192325.
Filippiadis D, Mauri G, Marra P, et al. Percutaneous ablation techniques for renal cell carcinoma: current status and future trends. Int J Hyperth. 2019;36:21–30. https://doi.org/10.1080/02656736.2019.1647352.
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;11:1618. https://doi.org/10.3390/diagnostics11091618.
Lucignani G, Rizzo M, Ierardi AM, et al. Percutaneous microwave ablation is comparable to cryoablation for the treatment of T1a renal masses: results from a cross-sectional study. Clin Genitourin Cancer. 2022;20:e506–11. https://doi.org/10.1016/j.clgc.2022.07.004.
Castellana R, Natrella M, Fanelli G, et al. Efficacy and safety of MWA versus RFA and CA for renal tumors: a systematic review and meta-analysis of comparison studies. Eur J Radiol. 2023;165:110943. https://doi.org/10.1016/j.ejrad.2023.110943.
Panhelleux M, Balssa L, David A, et al. Evaluation of local control after percutaneous microwave ablation versus partial nephrectomy: a propensity score matched study. Prog Urol. 2023. https://doi.org/10.1016/j.purol.2023.09.021.
Efthymiou E, Velonakis G, Charalampopoulos G, et al. Computed tomography-guided percutaneous microwave ablation for renal cell carcinoma: evaluating the performance of nephrometry scores. Eur Radiol. 2023. https://doi.org/10.1007/s00330-023-09774-y.
Cazalas G, Klein C, Piana G, et al. A multicenter comparative matched-pair analysis of percutaneous tumor ablation and robotic-assisted partial nephrectomy of T1b renal cell carcinoma (AblatT1b study—UroCCR 80). Eur Radiol. 2023;33:6513–21. https://doi.org/10.1007/s00330-023-09564-6.
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. https://doi.org/10.1016/j.urology.2019.09.024.
Yeaman C, Marchant R, Lobo JM, et al. Cost-effectiveness analysis: percutaneous microwave ablation vs robotic-assisted partial nephrectomy for small renal masses. Abdom Radiol. 2022;48:411–7. https://doi.org/10.1007/s00261-022-03692-1.
Junker T, Duus L, Rasmussen BSB, et al. Quality of life and complications after nephron-sparing treatment of renal cell carcinoma stage T1—a systematic review. Syst Rev. 2022;11:4. https://doi.org/10.1186/s13643-021-01868-2.
Acknowledgements
This work was conducted with support from Harvard Catalyst from Harvard University and its affiliated academic healthcare centers. The content is solely the responsibility of the authors and does not necessarily represent the official views of Harvard Catalyst, Harvard University, and its affiliated academic healthcare centers, or the National Institutes of Health.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that the research was conducted without any commercial or financial relationships that could be construed as a potential conflict of interest.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
Below is the link to the electronic supplementary material.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Chlorogiannis, DD., Kratiras, Z., Efthymiou, E. et al. Percutaneous Microwave Ablation Versus Robot-Assisted Partial Nephrectomy for Stage I Renal Cell Carcinoma: A Propensity-Matched Cohort Study Focusing Upon Long-Term Follow-Up of Oncologic Outcomes. Cardiovasc Intervent Radiol (2024). https://doi.org/10.1007/s00270-024-03695-z
Received:
Accepted:
Published:
DOI: https://doi.org/10.1007/s00270-024-03695-z