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Computed tomography-guided percutaneous microwave ablation for renal cell carcinoma: evaluating the performance of nephrometry scores

  • Interventional
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Abstract

Objectives

The purpose of the current study is to evaluate the performance of RENAL and mRENAL scores, in the prediction of oncological outcomes in patients treated with microwave ablation (MWA) for (T1) renal cell carcinomas (RCC).

Methods

Institutional database retrospective research identified 76 patients with a biopsy-proven solitary T1a (84%) or T1b (16%) RCC; all patients underwent CT-guided MWA ablation. Tumor complexity was reviewed by calculating RENAL and mRENAL scores.

Results

The majority of the lesions were exophytic (82.9%), with > 7 mm nearness to the collecting system (53.9%), located posteriorly (73.6%), and lower to polar lines (61.8%). Mean RENAL and mRENAL scores were 5.7 (SD = 1.9) and 6.1 (SD = 2.1) respectively. Progression rates were significantly higher with greater tumor size (> 4 cm), with < 4 mm nearness to the collecting system, for tumors crossing a polar line and with the anterior location. None of the above was associated with complications. RENAL and mRENAL scores were significantly higher in patients with incomplete ablation. The ROC analysis showed the significant prognostic ability of both RENAL and mRENAL scores for progression. In both scores, the optimal cut-off point was 6.5. Univariate Cox regression analysis for progression showed a hazard ratio of 7.73 for the RENAL score and 7.48 for the mRENAL score.

Conclusion

The results of the present study show that the risk of progression was higher in patients with RENAL and mRENAL score of > 6.5, in T1b tumors, close to the collective system (< 4 mm), crossing polar lines and anterior location.

Clinical relevance statement

CT-guided percutaneous MWA is a safe and effective technique for the treatment of T1a renal cell carcinomas. Different morphometric parameters of RCC tumors including RENAL and mRENAL score > 6.5, size, proximity to the collecting system, and crossing of polar lines impact the efficacy of MWA and progression survival rates.

Key Points

• The risk of progression is higher in patients with RENAL and mRENAL score > 6.5, in T1b tumors, close to the collective system (< 4 mm), crossing polar lines and anterior location.

• The significant prognostic ability of the mRENAL score for progression was higher than the respective of the RENAL score.

• Complications were not associated with any of the above factors.

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Abbreviations

CA:

Cryoablation

CIRSE:

Cardiovascular and Interventional Radiological Society of Europe

ECOG:

Eastern Cooperative Oncology Group

KPS:

Karnofsky performance scale

mRENAL:

modified radius tumor size as maximal diameter, exophytic/endophytic properties of the tumor, nearness of tumor deepest portion to the collecting system or sinus, anterior (a)/posterior (p) descriptor, and the location relative to the polar line

MWA:

Microwave ablation

RCC:

Renal cell carcinoma

RENAL:

Radius tumor size as maximal diameter, exophytic/endophytic properties of the tumor, nearness of tumor deepest portion to the collecting system or sinus, anterior (a)/posterior (p) descriptor, and the location relative to the polar line.

RFA:

Radiofrequency ablation

SE:

Standard error

References

  1. Znaor A, Lortet-Tieulent J, Laversanne M, Jemal A, Bray F (2015) International variations and trends in renal cell carcinoma incidence and mortality. Eur Urol 67(3):519–530

    PubMed  Google Scholar 

  2. Siegel RL, Miller KD, Jemal A (2018) Cancer statistics, 2018: Cancer Statistics, 2018. CA: Cancer J Clin 68(1):7–30

    PubMed  Google Scholar 

  3. Siegel RL, Miller KD, Jemal A (2020) Cancer statistics, 2020. CA: Cancer J Clin 70(1):7–30

    PubMed  Google Scholar 

  4. Katsanos K, Mailli L, Krokidis M, McGrath A, Sabharwal T, Adam A (2014) Systematic review and meta-analysis of thermal ablation versus surgical nephrectomy for small renal tumours. Cardiovasc Intervent Radiol 37(2):427–437

    CAS  PubMed  Google Scholar 

  5. Finelli A, Ismaila N, Russo P (2017) Management of small renal masses: American society of clinical oncology clinical practice guideline summary. J Oncol Pract 13(4):276–278

    PubMed  Google Scholar 

  6. Motzer RJ, Jonasch E, Agarwal N et al (2017) Kidney cancer, version 2. NCCN clinical practice guidelines in oncology. J Natl Compr Cancer Netw 15(6):804–834

    Google Scholar 

  7. Campbell S, Uzzo RG, Allaf ME et al (2017) Renal mass and localized renal cancer: AUA guideline. J Urol 198(3):520–529

    PubMed  Google Scholar 

  8. Escudier B, Porta C, Schmidinger M et al (2019) Renal cell carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 30(5):706–720

    CAS  PubMed  Google Scholar 

  9. Ljungberg B, Albiges L, Abu-Ghanem Y et al (2019) European association of urology guidelines on renal cell carcinoma: the 2019 update. Eur Urol 75(5):799–810

    PubMed  Google Scholar 

  10. Krokidis ME, Orsi F, Katsanos K, Helmberger T, Adam A (2017) CIRSE guidelines on percutaneous ablation of small renal cell carcinoma. Cardiovasc Intervent Radiol 40(2):177–191

    PubMed  Google Scholar 

  11. Aarts BM, Prevoo W, Meier MA et al (2020) Percutaneous microwave ablation of histologically proven t1 renal cell carcinoma. Cardiovasc Intervent Radiol 43(7):1025–1033

    CAS  PubMed  PubMed Central  Google Scholar 

  12. Hao G, Hao Y, Cheng Z et al (2018) Local tumor progression after ultrasound-guided percutaneous microwave ablation of stage T1a renal cell carcinoma: Risk factors analysis of 171 tumors. Int J Hyperth 35(1):62–70

    Google Scholar 

  13. Wells SA, Wheeler KM, Mithqal A, Patel MS, Brace CL, Schenkman NS (2016) 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 (NY) 41:1203–1211

    PubMed  Google Scholar 

  14. Gunn A, Rais-Bahrami S, Salei A et al (2019) Percutaneous cryoablation of stage T1b renal cell carcinoma: safety, technical results, and clinical outcomes. J Vasc Interv Radiol 30(3):S41

    Google Scholar 

  15. Efthymiou E, Siatelis A, Liakouras C et al (2021) Computed tomography-guided percutaneous microwave ablation for renal cell carcinoma: Impact of tumor size on the progression survival rates. Diagnostics 11(9):1618

    CAS  PubMed  PubMed Central  Google Scholar 

  16. Shakeri S, Afshari Mirak S, Mohammadian Bajgiran A et al (2019) The effect of tumor size and location on efficacy and safety of US- and CT- guided percutaneous microwave ablation in renal cell carcinomas. Abdom Radiol (NY) 44(6):2308–2315

    PubMed  Google Scholar 

  17. Maciolek KA, Abel EJ, Posielski NM et al (2019) Tumor location does not impact oncologic outcomes for percutaneous microwave ablation of clinical T1a renal cell carcinoma. Eur Radiol 29(11):6319–6329

    PubMed  Google Scholar 

  18. Klapperich ME, Abel EJ, Ziemlewicz TJ et al (2017) 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 284(1):272–280

    PubMed  Google Scholar 

  19. Kutikov A, Uzzo RG (2009) The R. E. N. A. L. Nephrometry score: a comprehensive standardized system for quantitating renal tumor size, location and depth. J Urol 182(3):844–853

    PubMed  Google Scholar 

  20. Gahan JC, Richter MD, Seideman CA et al (2015) The performance of a modified renal nephrometry score in predicting renal mass radiofrequency ablation success. Urology 85(1):125–129

    PubMed  Google Scholar 

  21. Schmit GD, Schenck LA, Thompson RH et al (2014) Predicting renal cryoablation complications: new risk score based on tumor size and location and patient history. Radiology 272(3):903–910

    PubMed  Google Scholar 

  22. Higgins LJ, Hong K (2015) Renal ablation techniques: state of the art. AJR Am J Roentgenol 205(4):735–741

    PubMed  Google Scholar 

  23. Filippiadis D, Mauri G, Marra P, Charalampopoulos G, Gennaro N, De Cobelli F (2019) Percutaneous ablation techniques for renal cell carcinoma: current status and future trends. Int J Hyperth 36(2):21–23

    CAS  Google Scholar 

  24. Zhou W, Arellano RS (2018) Thermal ablation of T1c renal cell carcinoma: a comparative assessment of technical performance, procedural outcome, and safety of microwave ablation, radiofrequency ablation, and cryoablation. J Vasc Interv Radiol 29:943–951

    PubMed  Google Scholar 

  25. Cornelis FH (2017) The future of percutaneous renal ablation. Diagn Interv Imaging 98:285–286

    CAS  PubMed  Google Scholar 

  26. Filippiadis DK, Binkert C, Pellerin O, Hoffmann RT, Krajina A, Pereira PL (2017) CIRSE quality assurance document and standards for classification of complications: the CIRSE classification system. Cardiovasc Intervent Radiol 40(8):1141–1146

    CAS  PubMed  Google Scholar 

  27. Cronan J, Dariushnia S, Bercu Z et al (2019) Systematic review of contemporary evidence for the management of T1 renal cell carcinoma: what IRs need to know for kidney cancer tumor boards. Semin Interv Radiol 36:194–202

    Google Scholar 

  28. Guo J, Arellano RS (2021) Percutaneous microwave ablation of category T1a renal cell carcinoma: intermediate results on safety, technical feasibility, and clinical outcomes of 119 tumors. AJR Am J Roentgenol 216:117–124

    PubMed  Google Scholar 

  29. Guo J, Arellano RS (2020) Percutaneous microwave ablation of stage t1b renal cell carcinoma: Short-term assessment of technical feasibility, short-term oncologic outcomes, and safety. J Endourol 34(10):1021–1027

    PubMed  Google Scholar 

  30. Simmons MN, Ching CB, Samplaski MK, Park CH, Gill IS (2010) Kidney tumor location measurement using the c index method. J Urol 183(5):1708–1713

    PubMed  Google Scholar 

  31. Ficarra V, Novara G, Secco S et al (2009) Preoperative aspects and dimensions used for an anatomical (Padua) classification of renal tumours in patients who are candidates for nephron-sparing surgery. Eur Urol 56(5):786–793

    PubMed  Google Scholar 

  32. Aladağ Kurt S, Yücel C, Özhan Oktar S, Erbaş G, Sözen TS, Öner AY (2019) The effectiveness of RENAL nephrometry score in ablated renal tumours via radiofrequency ablation or cryoablation. Turk J Med Sci 49(3):761–768

    PubMed  PubMed Central  Google Scholar 

  33. Maxwell AWP, Baird GL, Iannuccilli JD, Mayo-Smith WW, Dupuy DE (2017) Renal cell carcinoma: comparison of renal nephrometry and padua scores with maximum tumor diameter for prediction of local recurrence after thermal ablation. Radiology 283(2):590–597

    PubMed  Google Scholar 

  34. Sisul DM, Liss MA, Palazzi KL et al (2013) Renal nephrometry score is associated with complications after renal cryoablation: a multicenter analysis. Urology 81(4):775–780

    PubMed  Google Scholar 

  35. Camacho JC, Kokabi N, Xing M et al (2015) RENAL (radius, exophytic/endophytic, nearness to collecting system or sinus, anterior/posterior, and location relative to polar lines) nephrometry score predicts early tumor recurrence and complications after percutaneous ablative therapies for renal cell carcinoma: a 5-year experience. J Vasc Interv Radiol 26(5):686–693

    PubMed  Google Scholar 

  36. Reyes J, Canter D, Putnam S et al (2013) Thermal ablation of the small renal mass: case selection using the R. E. N. A. L. nephrometry score. Urol Oncol 31(7):1292–1297

    PubMed  Google Scholar 

  37. Ierardi AM, Puliti A, Angileri SA et al (2017) Microwave ablation of malignant renal tumours: intermediate-term results and usefulness of RENAL and mRENAL scores for predicting outcomes and complications. Med Oncol 34(5):97

    PubMed  Google Scholar 

  38. Seideman CA, Gahan J, Weaver M et al (2013) Renal tumour nephrometry score does not correlate with the risk of radiofrequency ablation complications: nephrometry scoring fails to predict complications of RFA for SRMS. BJU Int 112(8):1121–1124

    PubMed  Google Scholar 

  39. Mouli SK, McDevitt JL, Su Y-K et al (2017) Analysis of the RENAL and mRENAL scores and the relative importance of their components in the prediction of complications and local progression after percutaneous renal cryoablation. J Vasc Interv Radiol 28(6):860–867

    PubMed  Google Scholar 

  40. Porpiglia F, Volpe A, Billia M, Renard J, Scarpa RM (2008) Assessment of risk factors for complications of laparoscopic partial nephrectomy. Eur Urol 53(3):590–598

    PubMed  Google Scholar 

  41. Liu Z-W, Olweny EO, Yin G et al (2013) Prediction of perioperative outcomes following minimally invasive partial nephrectomy: role of the R.E.N.A.L nephrometry score. World J Urol 31(5):1183–1189

    PubMed  Google Scholar 

  42. Weizer AZ, Gilbert SM, Roberts WW, Hollenberg BK, Wolf JS Jr (2008) Tailoring technique of laparoscopic partial nephrectomy to tumor characteristics. J Urol 180:1273

    PubMed  Google Scholar 

  43. Pantelidou M, Challacombe B, McGrath A et al (2016) Percutaneous radiofrequency ablation versus robotic-assisted partial nephrectomy for the treatment of small renal cell carcinoma. Cardiovasc Intervent Radiol 39(11):1595–1603

    PubMed  PubMed Central  Google Scholar 

  44. Iguchi T, Hiraki T, Tomita K et al (2016) Simultaneous biopsy and radiofrequency ablation of T1a renal cell carcinoma. Diagn Interv Imaging 97(11):1159–1164

    CAS  PubMed  Google Scholar 

  45. Iannuccilli JD, Dupuy DE, Beland MD, Machan JT, Golijanin DJ, Mayo-Smith WW (2015) Effectiveness and safety of computed tomography-guided radiofrequency ablation of renal cancer: a 14-year single institution experience in 203 patients. Eur Radiol 26:1656–1664

    PubMed  Google Scholar 

  46. Wah TM, Irving HC, Gregory W, Cartledge J, Joyce AD, Selby PJ (2014) Radiofrequency ablation (RFA) of renal cell carcinoma (RCC): experience in 200 tumours: RFA for RCC. BJU Int 113(3):416–428

    PubMed  Google Scholar 

  47. Patel N, King AJ, Breen DJ (2016) Percutaneous image-guided cryoablation of small renal masses. Abdom Radiol (NY) 41(4):754–766

    PubMed  Google Scholar 

  48. Georgiades CS, Rodriguez R (2014) Efficacy and safety of percutaneous cryoablation for stage 1a/b renal cell carcinoma: results of a prospective, single-arm, 5-year study. Cardiovasc Intervent Radiol 37(6):1494–1499

    PubMed  Google Scholar 

  49. De Cobelli F, Papa M, Panzeri M et al (2020) Percutaneous microwave ablation versus cryoablation in the treatment of t1a renal tumors. Cardiovasc Intervent Radiol 43(1):76–83

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Second Department of Radiology, University General Hospital ATTIKON, National and Kapodistrian University of Athens, Rimini 1, 12462, Athens, Greece

    Evgenia Efthymiou, Georgios Velonakis, Georgios Charalampopoulos, Argyro Mazioti, Elias Brountzos, Nikolaos Kelekis & Dimitrios Filippiadis

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  1. Evgenia Efthymiou
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  2. Georgios Velonakis
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Correspondence to Evgenia Efthymiou.

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Guarantor

The scientific guarantor of this publication is Dimitrios Filippiadis.

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

Tzavara Chara kindly provided statistical advice for this manuscript. She is not one of the authors.

Informed consent

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

Ethical approval

Institutional Review Board approval was obtained.

The study was conducted according to the guidelines of the Declaration of Helsinki, and approved by the Institutional Review Board of UNIVERSITY GENERAL HOSPITAL “ATTIKON” (514/14.9.2020).

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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 33, 7388–7397 (2023). https://doi.org/10.1007/s00330-023-09774-y

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