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Percutaneous radiofrequency ablation is an effective treatment option for small renal masses, comparable to partial nephrectomy

  • Interventional
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Abstract

Objectives

The standard therapy for small renal masses (SRMs) remains partial nephrectomy (PN), which is associated with relatively high morbidity and complication rate. Therefore, percutaneous radiofrequency ablation (PRFA) emerges as an alternative therapy. This study aimed to compare the efficacy, safety, and oncological outcomes of PRFA versus PN.

Methods

A multicenter non-inferiority study with retrospective analysis of 291 patients with SRMs (N0M0), who underwent PN or PRFA (2:1), recruited prospectively from two hospitals in the Andalusian Public Health System, Spain, between 2014 and 2021. Comparisons of treatment features were evaluated using the t test, Wilcoxon-Mann–Whitney U test, chi-square test, Fisher test, and Cochran-Armitage trend test. Kaplan–Meier curves depicted overall survival (OS), local recurrence-free survival (LRFS), and metastasis-free survival (MFS) rates in the overall study population.

Results

A total of 291 consecutive patients were identified; 111 and 180 patients underwent PRFA and PN, respectively. Median follow-up time was 38 and 48 months, and mean hospitalization days were 1.04 and 3.57 days, respectively. The variables underpinned with high surgical risk were significantly increased in PRFA compared to those in PN (mean age was 64.56 and 57.47 years, the solitary kidney presence was 12.6% and 5.6%, ASA score ≥ 3 was 36% and 14.5%, respectively). The rest of oncological outcomes were comparable amongst PRFA and PN. Patients undergoing PRFA did not improve OS, LRFS, and MFS compared to those undergoing PN. Limitations comprise retrospective design and limited statistical power.

Conclusion

PRFA for SMRs in high-risk patients is non-inferior in terms of oncological outcomes and safety compared to PN.

Clinical relevance statement

Our study has a direct clinical application as it proves that radiofrequency ablation is an effective and uncomplicated therapeutic option for patients with small renal masses.

Key Points

•There are non-inferiority results in overall survival, local recurrence-free survival, and metastasis-free survival between PRFA and PN.

•Our two-center study showed that PRFA is non-inferior to PN in oncological outcomes.

•Contrast-enhanced power ultrasound-guided PRFA provides an effective therapy for T1 renal tumors.

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Abbreviations

CEPUS:

Contrast-enhanced power ultrasound

Cr:

Creatinine

CSS:

Cancer-specific survival

CT:

Computed tomography

eGFR:

Estimated glomerular filtration rate

LRFS:

Local recurrence-free survival

MFS:

Metastasis-free survival

MRI:

Magnetic resonance imaging

OS:

Overall survival

PN:

Partial nephrectomy

PRFA:

Percutaneous radiofrequency ablation

RCC:

Renal cell carcinoma

RN:

Radical nephrectomy

SRMs:

Small renal masses

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Acknowledgements

The authors are grateful for the commitment of the nurses and technicians involved in the appointments and assistance in surgery. In addition, they kindly acknowledge Patricia García-Sanz from BioMed Targets for her medical writing contributions and logistical support in preparing this manuscript.

Funding

The authors state that this work has not received any funding.

Author information

Authors and Affiliations

  1. Urology Clinical Unit, University Hospital of Jerez de La Frontera, Ctra. Trebujena, S/N, 11407, Jerez de La Frontera, Cádiz, Spain

    José Pablo Pedraza-Sánchez, Javier Mazuecos-Quirós, Álvaro Luis Bisonó-Castillo & Álvaro Juárez Soto

  2. Department of Urology and Nephrology, Virgen del Rocío University Hospital, Biomedical Institute of Seville (Ibis), CSIC/University of Seville, Seville, Spain

    Reyes Chaves-Marcos, Ignacio Osmán-García & Rafael Antonio Medina López

  3. Department of Radiology, Virgen del Rocío University Hospital, Biomedical Institute of Seville (Ibis), CSIC/University of Seville, Seville, Spain

    Carlos Miguel Gutiérrez-Marín

Authors
  1. José Pablo Pedraza-Sánchez
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  7. Rafael Antonio Medina López
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Corresponding author

Correspondence to José Pablo Pedraza-Sánchez.

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Guarantor

The scientific guarantor of this publication is Dr. José Pablo Pedraza-Sánchez.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

Biostatech kindly provided statistical advice for this manuscript.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was not required because the study is not a randomized clinical trial.

Study subjects or cohorts overlap

Not applicable.

Methodology

•prospective recruitment and retrospective analysis

•observational

•multicenter study

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Pedraza-Sánchez, J.P., Chaves-Marcos, R., Mazuecos-Quirós, J. et al. Percutaneous radiofrequency ablation is an effective treatment option for small renal masses, comparable to partial nephrectomy. Eur Radiol 33, 7371–7379 (2023). https://doi.org/10.1007/s00330-023-09779-7

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