Local tumor ablation (LTA) and non-interventional management (NIM) emerged as alternative management options for T1a renal cell carcinoma (RCC). We investigated trends and cancer-specific mortality (CSM) after LTA and NIM, compared to partial nephrectomy (PN).

Within the Surveillance, Epidemiology, and End Results database (2004-2015), T1a RCC patients treated with PN, LTA or NIM were identified. Estimated annual proportion change methodology (EAPC), 1:1 ratio propensity score (PS) matching, cumulative incidence plots and multivariable competing risks regression models (CRR) were used to compare LTA vs PN and NIM vs PN. Subgroup analyses focused on patients <65 and ≥65years.

Overall 4,524 patients underwent LTA vs 1,654 NIM vs 25,435 PN. Annuals rates increased for NIM (EAPC: +3.3%, p<0.001), but not for either LTA or PN. After PS-matching in multivariable CCR, LTA (HR 1.9, p<0.001) and NIM (HR 3.0, p<0.001) showed worse 5-year CSM, relative to PN. In subgroup analyses, LTA showed no CSM disadvantage relative to PN in younger patients (HR 2.0, p=0.07). In older patients 1.64-fold CSM increase was recorded. Conversely, NIM younger (HR 3.1, p=0.001) and older (HR 3.1, p<0.001) patients exhibited higher CSM relative to PN.

In T1a RCC patients, NIM rates showed a modest but significant increase, while LTA and PN rates remained stable. In survival analyses, LTA exhibited higher CSM rates only for elderly patients. Conversely, NIM exhibited higher CSM rates in both younger and older patients.

Minerva urologica e nefrologica = The Italian journal of urology and nephrology. 2019 Sep 04 [Epub ahead of print]

Carlotta Palumbo, Francesco A Mistretta, Sophie Knipper, Elio Mazzone, Angela Pecoraro, Zhe Tian, Paul Perrotte, Alessandro Antonelli, Francesco Montorsi, Shahrokh F Shariat, Fred Saad, Claudio Simeone, Alberto Briganti, Luke T Lavallee, Pierre I Karakiewicz

Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada – ., Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada., Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy., Urology Unit, Department of Medical and Surgical Specialties, Radiological Science and Public Health, ASST Spedali Civili of Brescia, University of Brescia, Brescia, Italy., Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), IRCCS San Raffaele Scientific Institute, Milan, Italy., Division of Urology, University of Montreal Hospital Center (CHUM), Montreal, QC, Canada., Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia.