A recent study from researchers at the Mayo Clinic (MN, USA) suggests that needle-guided tumor destruction procedures offer near equivalent lengths of local cancer control, compared with surgery for patients with small kidney cancer tumors. The results have prompted the authors to suggest that, if the data are validated, an update to clinical guidelines would be warranted.
In the study, 1803 patients with primary cT1N0M0 renal masses treated between 2000 and 2011 were identified from the prospectively maintained Mayo Clinic Renal Tumor Registry. The authors reported that in this cohort of sporadic cT1 renal masses, they observed that recurrence-free survival was similar for partial nephrectomy and percutaneous ablation patients.
Metastases-free survival was superior for partial nephrectomy and cryoablation patients when compared with radiofrequency ablation for cT1a patients. Overall survival was superior after partial nephrectomy, probably due to selection bias.
Discussing the study, R. Houston Thompson (Mayo Clinic), one of the study authors, commented that radical nephrectomy has historically been the standard of care for management of kidney cancer; however, partial nephrectomy has become increasingly more common because of its nephron-sparing benefits and similar cancer control.
Explaining why the study was conducted, Thompson explained: “We undertook this study because direct comparisons of outcomes among patients with kidney cancer who have received partial nephrectomy and cryoablation are lacking, especially from institutions that routinely perform all three of these procedures.”
Sources: Thompson RH, Atwell T, Schmit G, et al. Comparison of Partial Nephrectomy and Percutaneous Ablation for cT1 Renal Masses. European Urology doi: 10.1016/j.eururo.2014.07.021 (2014); Mayo Clinic press release