JU INSIGHT Cancer-specific Mortality After Cryoablation vs Heat-based Thermal Ablation in T1a Renal Cell Carcinoma

Attention: Restrictions on use of AUA, AUAER, and UCF content in third party applications, including artificial intelligence technologies, such as large language models and generative AI.
You are prohibited from using or uploading content you accessed through this website into external applications, bots, software, or websites, including those using artificial intelligence technologies and infrastructure, including deep learning, machine learning and large language models and generative AI.

JU INSIGHT: Cancer-specific Mortality After Cryoablation vs Heat-based Thermal Ablation in T1a Renal Cell Carcinoma

By: Gabriele Sorce, MD; Benedikt Hoeh, MD; Lukas Hohenhorst, MD; Andrea Panunzio, MD; Stefano Tappero, MD; Zhe Tian, MSc; Andrea Kokorovic, MD; Alessandro Larcher, MD; Umberto Capitanio, MD; Derya Tilki, MD; Carlo Terrone, MD; Felix K. H. Chun, MD; Alessandro Antonelli, MD; Fred Saad, MD; Shahrokh F. Shariat, MD; Francesco Montorsi, MD; Alberto Briganti, MD; Pierre I. Karakiewicz, MD | Posted on: 17 Jan 2023

Sorce G, Hoeh B, Hohenhorst L, et al. Cancer-specific mortality after cryoablation vs heat-based thermal ablation in T1a renal cell carcinoma. J Urol. 2023;209(1):81-88.

Study Need and Importance

Both cryoablation (CA) and heat-based thermal ablation (hTA) represent alternative management options for frail and/or comorbid T1a renal cell carcinoma patients when curative intent is sought, according to the current National Comprehensive Cancer Network guidelines. Conversely, the European Association of Urology guidelines recommend CA over hTA in patients with tumor size 3.1-4 cm, while either technique is recommended for those with tumor size ≤3 cm. The distinction between National Comprehensive Cancer Network vs European Association of Urology recommendations for patients with tumor size 3.1-4 cm is based on a very limited amount of data, mostly originating from case series. Our analyses distinguished themselves from previous reports by propensity score matching (PSM) and competing risks regression (CRR) adjusted for other-cause mortality, which accounts for most mortalities in T1a patients who are candidates for tumor ablation.

What We Found

In patients with tumor size 3.1-4 cm, after up to 2:1 PSM that resulted in 757 CAs vs 388 hTAs, the 8-year cancer-specific mortality (CSM) rate was 8.5% vs 12.9% (see Figure). In multivariable CRR models, hTA was associated with higher CSM (HR:2.02, P < .001) relative to CA. In patients with tumor size ≤3 cm, after up to 2:1 PSM that resulted in 2,217 CAs vs 1,114 hTAs, the 8-year CSM rate was 6.8% vs 6.1%. In multivariable CRR models, hTA was not associated with higher CSM (HR:1.13, P = .5) relative to CA.

Limitations

The retrospective nature and lack of data on earlier cancer control endpoints, such as local recurrence and/or disease-free survival, are limitations. Moreover, lack of information about retreatment, comorbidities, number of tumors, tumor location within the kidney, and type of ablation approach (percutaneous or laparoscopic) were missing but nondifferentially influenced both groups.

Interpretation for Patient Care

In patients with tumor size 3.1-4 cm, hTA was associated with a twofold CSM disadvantage, relative to CA. Conversely, in patients with tumor size ≤3 cm, either ablation technique was equally valid.