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JU INSIGHT A Comparison of Percutaneous Ablation Therapy to Partial Nephrectomy for cT1a Renal Cancers: Results from the Canadian Kidney Cancer Information System
By: Braden Millan, MD; Rodney H. Breau, MD; Bimal Bhindi, MD; Ranjeeta Mallick; Simon Tanguay, MD; Antonio Finelli, MD; Luke T. Lavallle, MD; Frederic Pouliot, MD; Ricardo Rendon, MD; Alan I. So, MD; Lucas Dean, MD; Jean-Baptiste Lattouf, MD; Naveen S. Basappa, MD; Anil Kapoor, MD | Posted on: 01 Oct 2022
Millan B, Breau RH, Bhindi B, et al. A Comparison of Percutaneous Ablation Therapy to Partial Nephrectomy for cT1a Renal Cancers: Results from the Canadian Kidney Cancer Information System. J Urol. 2022;208(4)804-812.
Study Need and Importance
Percutaneous ablation therapy (AT) and partial nephrectomy (PN) are accepted treatments for T1a renal cancer; however, the strength of evidence comparing these remains limited by patient selection bias. Furthermore, randomized feasibility studies have shown poor recruitment rates with early trial termination. As such, large multicenter observational studies remain the highest level of evidence comparing these treatments.
What We Found
In a large multi-institutional prospective cohort, as expected, significant clinical selection bias was present for patients who received AT (275 patients) compared to PN (2,001). Using propensity score adjustment, we reduced the effect of selection bias, which is reflected in similar overall survival between propensity-adjusted cohorts (5-year overall survival was 94.2% and 95.1% for AT and PN, respectively; p=0.7). Risk of recurrence, although low with both approaches, was significantly higher in those treated with AT compared to PN, with a 5-year recurrence-free survival following propensity score adjustments of 86.0% and 95.1%, respectively (p=0.003).
Limitations
In observational studies, the allocation of patients to treatment groups is impacted by patient and physician factors. Historically, and as we observed, AT cohorts are enriched with patients with shorter life expectancy due to more advanced age and increased comorbidities compared to PN cohorts. Using propensity score adjustment, we reduced this confounding, although residual confounding due to unmeasured factors such as tumor location and complexity may remain. Relatively short followup and loss to followup are also limitations to these data.
Interpretation for Patient Care
Recurrence rates after AT and PN for pT1a renal cancers are low. In a large multicenter prospective cohort, patients receiving AT had a higher risk of recurrence compared to PN.
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