Percutaneous ablation may be preferred to nephrectomy for selected patients with early-stage renal cancer

Patients with stage T1a renal cancer may do better with percutaneous ablation than with nephrectomy, according to a new study.

Researchers performed an observational cohort analysis using Medicare-linked data from the Surveillance, Epidemiology, and End Results (SEER) registry to compare outcomes in patients with stage T1a renal cancer who were treated with percutaneous ablation, partial nephrectomy, or radical nephrectomy. The primary outcome measures were renal cancer-specific and overall survival and complications at 30 and 365 days postintervention. The study was published June 26 by Annals of Internal Medicine.

Overall, 4,310 patients ages 66 years and older who were treated for stage T1a renal cancer between 2006 and 2011 were included in the study. Of these, 456 (11%) received percutaneous ablation, 1,748 (40%) received partial nephrectomy, and 2,106 (49%) received radical nephrectomy as primary treatment. Use of radical nephrectomy decreased over time while use of the other two procedures increased. Patients were followed for a median of 52 months for overall survival and 42 months for renal cancer-specific survival.

Renal cancer-specific survival at five years was 95% (95% CI, 93% to 98%) versus 98% (95% CI, 96% to 99%) after percutaneous ablation versus partial nephrectomy and 96% (95% CI, 94% to 98%) versus 95% (95% CI, 93% to 96%) after percutaneous ablation versus radical nephrectomy. Overall survival at five years was 77% (95% CI, 74% to 81%) versus 86% (95% CI, 84% to 88%) after percutaneous ablation versus partial nephrectomy and 74% (95% CI, 71% to 78%) versus 75% (95% CI, 73% to 77%) after percutaneous ablation versus radical nephrectomy. Thirty-one to 365 days after percutaneous ablation, partial nephrectomy, and radical nephrectomy, cumulative rates of renal insufficiency were 11% (95% CI, 8% to 14%), 9% (95% CI, 8% to 10%), and 18% (95% CI, 17% to 20%), and rates of nonurologic complications within 30 days postintervention were 6% (95% CI, 4% to 9%), 29% (95% CI, 27% to 30%), and 20% (95% CI, 28% to 32%), respectively.

The authors noted that their data were observational and that their findings may have been affected by residual confounding or selection bias and are probably not generalizable to younger patients, among other limitations. They concluded that cancer-related outcomes may be similar with percutaneous ablation and radical nephrectomy for certain older adult patients with stage T1a renal cancer, but the former procedure may lead to less renal insufficiency in the longer term and fewer periprocedural complications. Patients who receive partial nephrectomy, meanwhile, may have slightly better renal cancer-specific survival but more periprocedural complications than those who receive percutaneous ablation.

“This large, population-based comparative analysis of [percutaneous ablation] outcomes strengthens the findings of recent institutional studies and raises the level of evidence in support of [percutaneous ablation] for well-selected older patients with small renal tumors,” the authors wrote.