Presentation Authors: Jack Andrews*, Tom Atwell, Grant Schmit, Christine Lohse, Nicholas Kurup, Adam Weisbrod, Matthew Callstrom, John Cheville, Stephen Boorjian, Bradley Leibovich, R. Houston Thompson, Rochester, MN
Introduction: Partial nephrectomy (PN) is the primary treatment modality for cT1 renal masses, yet high quality data comparing PN and thermal ablation is lacking. We sought to review and update our experience with PN, percutaneous radiofrequency ablation (RFA), and percutaneous cryoablation for cT1 renal masses with additional follow up.
Methods: We identified 1,798 patients with primary cT1N0M0 renal masses treated between 2000 and 2011 from the prospectively maintained Mayo Clinic Renal Tumor Registry. Local recurrence-free, metastases-free, and cancer-specific survival were estimated using the Kaplan-Meier method and compared with log-rank tests.
Results: Among 1422 cT1a patients, 1055, 180, and 187 underwent PN, RFA, and cryoablation, respectively. Median clinical follow-up for survivors was 9.4, 7.5, and 6.3 years for PN, RFA, and cryoablation patients, respectively during which time local recurrence-free (p=0.29), metastases-free, (p=0.18), and cancer-specific survival (p=0.19) were comparable among the three treatments. Among 376 cT1b patients, 324 underwent PN and 52 were managed with cryoablation. Median clinical follow-up for survivors was 8.7 and 6.0 years for PN and cryoablation patients, respectively, during which time local recurrence-free (p=0.47),metastases-free (p=0.94), and cancer-specific survival (p=0.13) were comparable between PN and cryoablation. Limitations include retrospective review and selection bias.
Conclusions: In this large cohort, single institution experience with long-term follow up, we report similar local recurrence-free, metastases-free and cancer specific survival for partial nephrectomy and thermal ablation treatment modalities for cT1 renal masses. Overall survival remained superior after PN, although is likely attributable to selection bias. These results further support recently updated guidelines.