Cancer-specific Mortality in T1a Renal Cell Carcinoma Treated with Local Tumor Destruction Versus Partial Nephrectomy

Gabriele Sorce; Benedikt Hoeh; Lukas Hohenhorst; Andrea Panunzio; Stefano Tappero; Zhe Tian; Andrea Kokorovic; Alessandro Larcher; Umberto Capitanio; Derya Tilki; Carlo Terrone; Felix K H Chun; Alessandro Antonelli; Fred Saad; Shahrokh F Shariat; Francesco Montorsi; Alberto Briganti; Pierre I Karakiewicz

doi:10.1016/j.euf.2022.07.005

Cancer-specific Mortality in T1a Renal Cell Carcinoma Treated with Local Tumor Destruction Versus Partial Nephrectomy

Eur Urol Focus. 2023 Jan;9(1):125-132. doi: 10.1016/j.euf.2022.07.005. Epub 2022 Jul 30.

Authors

Gabriele Sorce¹, Benedikt Hoeh², Lukas Hohenhorst³, Andrea Panunzio⁴, Stefano Tappero⁵, Zhe Tian⁶, Andrea Kokorovic⁶, Alessandro Larcher⁷, Umberto Capitanio⁷, Derya Tilki⁸, Carlo Terrone⁵, Felix K H Chun⁹, Alessandro Antonelli¹⁰, Fred Saad⁶, Shahrokh F Shariat¹¹, Francesco Montorsi⁷, Alberto Briganti⁷, Pierre I Karakiewicz⁶

Affiliations

¹ Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy; Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada. Electronic address: [email protected].
² Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany.
³ Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
⁴ Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy.
⁵ Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy.
⁶ Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada.
⁷ Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy.
⁸ Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, Koc University Hospital, Instanbul, Turkey.
⁹ Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany.
¹⁰ Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy.
¹¹ Departments of Urology, Weill Cornell Medical College, New York, NY, USA; Department of Urology, University of Texas Southwestern, Dallas, TX, USA; Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic; Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia; Division of Urology, Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan; Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.

PMID: 35918270
DOI: 10.1016/j.euf.2022.07.005

Abstract

Background: Large-scale analyses addressing cancer-specific mortality (CSM) in T1a renal cell carcinoma (RCC) patients treated with local tumor destruction (LTD), relative to partial nephrectomy (PN), are scarce.

Objective: To compare CSM after LTD versus PN.

Design, setting, and participants: Within the Surveillance, Epidemiology, and End Results (SEER) database (2004-2018), we identified patients with clinical T1a stage RCC treated with LTD or PN.

Outcome measurements and statistical analyses: After 1:1 ratio propensity score matching (PSM) between patients treated with LTD versus PN, competing risks regression (CRR) models addressed CSM, after adjustment for other-cause mortality (OCM) and other covariates (age, tumor size, tumor grade, and histological subtype).

Results and limitations: Relative to the 35 984 PN patients, 5936 LTD patients were older and more frequently harbored unknown RCC histological subtype or unknown grade. After 1:1 PSM that resulted in 5352 LTD versus 5352 PN patients, the 10-yr CSM rate was 8.7% versus 5.5%. In multivariable CRR models, LTD was associated with higher CSM, relative to PN (hazard ratio [HR]: 1.58, p < 0.001). Subgroup analyses revealed invariably higher CSM after LTD versus PN in patients with tumor size ≤3 cm (10-yr CSM 7.2% vs 5.3%, multivariable HR: 1.47, p < 0.001) and in patients with tumor size 3.1-4 cm (10-yr CSM 11.4% vs 6.1%, multivariable HR: 1.72, p < 0.001). Lack of information regarding earlier cancer controls, retreatment, tumor location within the kidney, and type of surgery represented limitations.

Conclusions: In T1a RCC patients, LTD is invariably associated with higher CSM relative to PN, even after adjustment for OCM and all available patient and tumor characteristics, and regardless of tumor size considerations. However, the magnitude of CSM disadvantage was more pronounced in LTD patients with tumor size 3.1-4 cm than in those with tumor size ≤3 cm.

Patient summary: In patients with small renal masses, we observed higher cancer-specific death rates for local tumor destruction (LTD) than for partial nephrectomy. The LTD disadvantage was more pronounced for patients with tumor size 3.1-4 cm, but was also present in those with tumor size ≤3 cm.

Keywords: Cryoablation; Focal therapy; Microwave ablation; Minimally invasive; Radiofrequency ablation.

MeSH terms

Carcinoma, Renal Cell* / pathology
Humans
Kidney / surgery
Kidney Neoplasms* / pathology
Nephrectomy / methods
Proportional Hazards Models