MIS Image Guided/ Focal-cryo/RFA/HIFU: Kidney

Moderated Poster Session

MP23-12 - Ten-Year Experience with Percutaneous Cryoablation of Renal Tumors: Tumor Size Predicts Treatment Failure

Saturday, September 22
2:00 PM - 4:00 PM
Location: Room 253

Introduction & Objective :

Percutaneous cryoablation (PCA) of renal tumors is an accepted alternative to extirpative treatment in selected patients.  Although disease recurrence is thought to occur most commonly in the early post-procedure period, long-term oncologic follow-up is lacking.  We reviewed our ten-year experience with PCA for renal tumors and examined predictors of treatment failure.   


Methods : We examined our prospectively maintained database of patients who underwent renal PCA from March 2005 to December 2015 (n=308).  Baseline patient and tumor variables were recorded, and post-operative clinically-obtained cross-sectional imaging was recorded for evidence of disease.  Kaplan-Meier estimated survival curves were generated for disease-free survival (DFS) and Cox proportional hazards analysis was performed for predictors of DFS.  


Results : Mean patient age was 67.2+11 years, mean tumor size was 2.7+1.3 cm, mean nephrometry score was 6.8+1.7.  At mean follow-up of 38 months, disease progression (e.g. new lymphadenopathy or metastasis) was noted in 6.2% (19/308) of patients, while local recurrence was noted in 10.1% (31/308) of patients.  The Kaplan-Meier estimated DFS curve is provided in Figure 1.  An initial plateau occurs approximately 24 months after PCA; however, an equal number of treatment failures occur between 24 to 60 months.  Controlling for age, body-mass-index, comorbidity, tumor location and polarity, tumor size was a significant predictor of treatment failure (HR 1.33, p=0.001; per 1 cm increase in size).  Additionally, chronic obstructive pulmonary disease was a significant predictor of treatment failure (HR 3.04, p=0.02).    


Conclusions : In our ten-year experience with PCA for renal tumors, we find that treatment failure occurs in approximately 10% of cases, and not uncommonly after 24 months post-procedure.  Tumor size is a significant predictor of treatment failure (33%, 76%, 135% increased likelihood for 1, 2, and 3 cm increases in tumor size). 

Eric H. Kim

Assistant Professor
Washington University in St. Louis

Eric H. Kim, M.D., is an Assistant Professor of Surgery in the Division of Urologic Surgery at Washington University School of Medicine in St. Louis. Clinically, he specializes in robotic surgery for urologic cancers. His research focuses on imaging in prostate cancer.

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    Joel Vetter

    Statistician
    Washington University in St. Louis

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      Nicholas A. Pickersgill

      Medical Student
      Washington University School of Medicine in St. Louis

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        Robert Figenshau

        Professor
        Washington University in St. Louis

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