Cryoablation Best for Cancer-Specific Mortality in cT1a RCC

Patients with cT1a renal cell carcinoma (RCC) who underwent heat-based thermal ablation of a tumor sized 3.1-4 cm had twofold increased cancer-specific mortality as compared with cryoablation, according to a recent study in Journal of Urology.

However, for patients with tumors 3 cm or smaller, either ablation method worked.

“Cryoablation (CA) and heat-based thermal ablation (hTA) represent alternative management options for frail and/or comorbid RCC patients with tumor size 3.1-4 cm, as well as for patients with tumor size ≤3 cm, according to the most contemporary National Comprehensive Cancer Network (NCCN) guidelines,” the study researchers explained.

Guidelines from the NCCN and the European Association of Urology recommended CA over hTA in 3.1-4 cm tumors, and either technique in smaller tumors. This study was designed to provide additional evidence as to the most appropriate ablation methods.

The researchers used data from 1,468 patients with T1a RCC from the SEER database 2004-2018. They used 2:1 ratio propensity score matching between patients treated with CA or hTA and looked at cancer-specific mortality.

Of the included patients with tumors 3.1-4 cm, the majority (n=1,080) were treated with CA. The 8-year cancer-specific mortality was 8.5% for CA compared with 12.9% for hTA (P<.01). Other cause mortality at 8 years was similar for CA and hTA. After propensity score matching, a multivariable model showed that hTA was associated with higher cancer-specific mortality (hazard ratio [HR]=2.02; P<.01) compared with CA.

Of the 4,468 patients with tumors 3 cm or less, 3,354 were treated with CA. After propensity score matching, multivariable models showed no increased cancer-specific mortality associated with hTA compared with CA (HR=1.13; P=.5).

Several limitations were noted including the retrospective nature of the study and a lack of data on retreatment, comorbidities, number of tumors, tumor location and type of ablation approach. Despite that, the researchers noted that these findings should be considered during clinical decision making.

Reference

Cancer-Specific Mortality After Cryoablation vs Heat-Based Thermal Ablation in T1a Renal Cell Carcinoma