TOPLINE:

Among patients with T1a renal cell carcinoma (T1a RCC), ablation and surgical resection showed comparable risks for tumor progression. However, ablation was associated with higher rates of local recurrence but fewer complications and shorter hospital stays than resection or nephrectomy.

METHODOLOGY:

• Although the use of ablation for T1a RCC has increased due to its minimally invasive approach and fewer complications, knowledge about its long-term effectiveness and postoperative outcomes remains limited.
• Researchers analyzed data from Danish healthcare registries to compare long-term outcomes of ablation, surgical resection, and nephrectomy in 1862 patients (median age, 64 years; 29.9% women) diagnosed with T1a RCC (tumors with diameter < 4 cm) from 2013 to 2021.
• Patients were stratified into the ablation group (cryoablation or radiofrequency ablation; n = 540), the surgical resection group (partial nephrectomy; n = 1002), or the nephrectomy group (n = 320).
• The primary outcome was disease progression, defined as distant metastasis or local recurrence of tumors.
• Secondary outcomes included hospital length of stay and the number of 30-day posttreatment hospital contacts (excluding routine follow-ups).

TAKEAWAY:

• Compared with the resection group, neither the ablation group (hazard ratio [HR], 1.46; P = .40) nor the nephrectomy group (HR, 0.91; P = .79) had a higher risk for progression after adjusting for confounders.
• Local recurrence was rare but occurred most frequently in the ablation group (2.4%) compared with the resection (1.2%) and nephrectomy (0%) groups. Distant metastasis was most common in the nephrectomy group (4.4%), followed by the resection group (1.9%) and the ablation group (1.7%).
• Hospital stays were shortest for the ablation group (median, 0 days) compared with the resection and nephrectomy groups (median, 2 days for both).
• Ablation also resulted in the fewest posttreatment hospital contacts within 30 days (median, 1; IQR, 0-2) compared with resection and nephrectomy (median, 1; interquartile range [IQR], 1-2 for both).

IN PRACTICE:

“Follow-up data revealed that most local recurrences in patients who underwent ablation were successfully treated with additional ablation or surgery,” the authors wrote.

“[T]his study suggests ablation as a less invasive alternative to surgery for patients with T1a RCC, resulting in a similar high level of oncologic control,” they added.

SOURCE:

This study was led by Johanne Ahrenfeldt, PhD, MScEng, Aarhus University Hospital, Denmark. It was published online in Radiology.

LIMITATIONS:

The retrospective design contributed to inherent biases in patient selection and unmeasured confounding variables. The study also lacked complete information on tumor size for some patients. Additionally, the lack of systematic recording of complication types prevented direct comparisons of adverse events between treatment groups. 

DISCLOSURES:

The study received financial support from Købmand Inger Bonnens Fond, Lizzi og Mogens Staal Fonden, and Fabrikant Einar Willumsens Mindelegat. One author reported receiving a fellow grant from the Lundbeck Foundation (outside the submitted work) and project grants from several Danish foundations and societies, including the Danish Cancer Society and other sources.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.