Local ablation vs partial nephrectomy in T1N0M0 renal cell carcinoma: An inverse probability of treatment weighting analysis.
Aged
Aged, 80 and over
Carcinoma, Renal Cell
/ mortality
Cryosurgery
/ adverse effects
Female
Humans
Kidney Neoplasms
/ mortality
Male
Middle Aged
Neoplasm Staging
Nephrectomy
/ adverse effects
Radiofrequency Ablation
/ adverse effects
Retrospective Studies
SEER Program
Time Factors
Treatment Outcome
United States
SEER
ablation
outcomes
partial nephrectomy
renal cell carcinoma
surgery
Journal
Cancer medicine
ISSN: 2045-7634
Titre abrégé: Cancer Med
Pays: United States
ID NLM: 101595310
Informations de publication
Date de publication:
11 2020
11 2020
Historique:
received:
05
07
2020
revised:
14
08
2020
accepted:
16
08
2020
pubmed:
6
9
2020
medline:
20
7
2021
entrez:
5
9
2020
Statut:
ppublish
Résumé
To compare the survival outcomes of local ablation (LA) and partial nephrectomy (PN) for T1N0M0 renal cell carcinoma (RCC). We identified 38,155 T1N0M0 RCC patients treated with PN or LA in 2004-2016 from the retrospective Surveillance, Epidemiology, and End Results databases. Among them, there were 4656 LA and 33,499 PN. A Cox proportional hazards regression model, cause-specific Cox regression and Fine and Gray sub-distribution hazard ratio (sHR) with inverse probability of treatment weighting (IPTW) adjusting was utilized to compare the effects of LA vs PN on all-, RCC-, and non-RCC-caused mortality. Within the IPTW analysis, patients who underwent PN experienced a better overall survival (OS) (HR, 1.56; 95% CI, 1.40-1.74; P < .001) and cancer-specific survival (CSS) (HR, 2.21; 95% CI, 1.62-2.98; P < .001) than LA patients. In the subgroup of patients >85 years (HR, 1.14; 95% CI, 0.73-1.79, P = .577), chromophobe RCC (HR, 1.68; 95% CI, 0.94-3.00, P = .078), and tumor size <2 cm (HR, 1.21; 95% CI, 0.95-1.53, P = .126), the OS showed no significant difference between LA and PN. No significant difference in CSS between LA and PN was observed in the subgroup of chromophobe RCC (HR, 0.34; 95% CI, 0.03-3.97, P = .389), and tumor size <2 cm (HR, 1.83; 95% CI, 0.92-3.64, P = .084). For patients >85 years (sHR, 0.89; 95% CI, 0.52-1.27, P = .520) and tumor size <2 cm (sHR, 1.14; 95% CI, 0.94-1.38, P = .200), the non-RCC-specific mortality was not significantly different in PN and LA cohorts, however, for the chromophobe RCC, the LA showed a worse non-RCC mortality than PN (HR, 1.72; 95% CI, 1.06-2.79, P = .028). PN showed a better prognosis than LA in T1N0M0 RCC treatment, but LA and PN showed a comparable OS in elderly patients (>85), small RCC (<2 cm) and chromophobe RCC.
Identifiants
pubmed: 32888392
doi: 10.1002/cam4.3433
pmc: PMC7643644
doi:
Types de publication
Comparative Study
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
7988-8003Informations de copyright
© 2020 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.
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