Nicholas A Pickersgill, Joel M Vetter, Dylan J Mittauer, Lauren Elson, Joshua K Palka, Nimrod S Barashi, Eric H Kim, Ramakrishna Venkatesh, Sam B Bhayani, R Sherburne Figenshau
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引用次数: 0
Abstract
Purpose: Cryoablation (CA) and partial nephrectomy (PN) are effective nephron-sparing treatments for small renal masses. While guidelines list thermal ablation as an option for tumors <3 cm, limited data compare PN and CA in larger tumors. We compared intermediate-term oncologic outcomes between PN and CA in renal masses >3 cm.
Materials and methods: Patients treated with PN or CA for cT1/cT2, N0M0 renal masses >3 cm between 2006 and 2016 were identified. Propensity score matching was performed in a 1:2 ratio for patients undergoing CA or PN based on age, BMI, Charlson Comorbidity Index (CCI), tumor size, and nephrometry score. Disease-free survival (DFS), metastasis-free survival (MFS), cancer-specific survival (CSS), and overall survival (OS) were estimated using Kaplan-Meier analysis.
Results: One hundred thirteen and 57 patients underwent PN and CA with median follow-up of 4.5 and 3.8 years, respectively. CA was associated with significantly lower 5-year DFS compared to PN (75% vs. 94%, p<0.001). Local recurrence was more common after CA compared to PN (5.3% vs. 1.8%). Technical failure occurred with 32% of PCA. However, no significant differences were observed in 5-year MFS (100% for CA vs. 96% for PN, p=0.2) or CSS (100% for CA vs. 98% for PN, p=0.4).
Conclusions: CA is associated with lower DFS but similar MFS and CSS compared to PN in renal masses >3 cm. CA is a viable option for well-selected patients with comorbidities or high surgical risk, when combined with salvage ablation as indicated.
期刊介绍:
The Official Journal of the American Urological Association (AUA), and the most widely read and highly cited journal in the field, The Journal of Urology® brings solid coverage of the clinically relevant content needed to stay at the forefront of the dynamic field of urology. This premier journal presents investigative studies on critical areas of research and practice, survey articles providing short condensations of the best and most important urology literature worldwide, and practice-oriented reports on significant clinical observations.