Percutaneous Ablation Versus Surgical Resection for Local Recurrence Following Partial Nephrectomy for Renal Cell Cancer: A Propensity Score Analysis (REPART Study-UroCCR 71).
Local recurrence
Outcome
Partial nephrectomy
Percutaneous ablation
Renal cell carcinoma
Surgery
Journal
European urology focus
ISSN: 2405-4569
Titre abrégé: Eur Urol Focus
Pays: Netherlands
ID NLM: 101665661
Informations de publication
Date de publication:
Jan 2022
Jan 2022
Historique:
received:
13
09
2020
revised:
20
12
2020
accepted:
09
02
2021
pubmed:
25
2
2021
medline:
15
4
2022
entrez:
24
2
2021
Statut:
ppublish
Résumé
Data comparing percutaneous ablation (PCA) and surgical resection (SR) for an isolated local recurrence (LR) following partial nephrectomy (PN) for renal cell carcinoma (RCC) are lacking. To examine the outcomes between PCA and SR for an isolated LR following PN for RCC. Patients who underwent PN for RCC and developed an LR between 2013 and 2019 were included. An LR was defined as the appearance of a mass in contact with the resection bed or the development of a tumor in the same region of the homolateral kidney as the original site. PCA or SR. To achieve balance in baseline characteristics, we used inverse probability of treatment weighting (IPTW) based on propensity to receive treatment. Oncological outcomes, complications, and renal function were evaluated between groups using logistic, linear, and Cox proportional hazard regression models. A total of 81 patients with an isolated LR were included (PCA: 42; SR: 39). The median follow-up was 23 mo. After adjustment, excellent balance was achieved for the majority of propensity score variables. In IPTW analysis, PCA was associated with a lower risk of postoperative complications (odds ratio=0.22; p=0.006) and a smaller change in eGFR (beta=-16.18; p=0.001). There were no significant differences in the risk of disease recurrence (hazard ratio [HR]=0.72; p=0.61), new LR (HR=1.51; p=0.59), and distant metastasis (HR=0.19; p=0.09). Limitations include the sample size and unmeasured confounding factors. Our results suggest that PCA provides comparable oncological outcomes to repeat surgery with fewer complications and better renal function preservation for the management of an LR after PN. This report shows that percutaneous ablation can be used for treating a local recurrence of renal cell carcinoma after partial nephrectomy, without significantly compromising cancer control.
Sections du résumé
BACKGROUND
BACKGROUND
Data comparing percutaneous ablation (PCA) and surgical resection (SR) for an isolated local recurrence (LR) following partial nephrectomy (PN) for renal cell carcinoma (RCC) are lacking.
OBJECTIVE
OBJECTIVE
To examine the outcomes between PCA and SR for an isolated LR following PN for RCC.
DESIGN, SETTING, AND PARTICIPANTS
METHODS
Patients who underwent PN for RCC and developed an LR between 2013 and 2019 were included. An LR was defined as the appearance of a mass in contact with the resection bed or the development of a tumor in the same region of the homolateral kidney as the original site.
INTERVENTION
METHODS
PCA or SR.
OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS
METHODS
To achieve balance in baseline characteristics, we used inverse probability of treatment weighting (IPTW) based on propensity to receive treatment. Oncological outcomes, complications, and renal function were evaluated between groups using logistic, linear, and Cox proportional hazard regression models.
RESULTS AND LIMITATIONS
CONCLUSIONS
A total of 81 patients with an isolated LR were included (PCA: 42; SR: 39). The median follow-up was 23 mo. After adjustment, excellent balance was achieved for the majority of propensity score variables. In IPTW analysis, PCA was associated with a lower risk of postoperative complications (odds ratio=0.22; p=0.006) and a smaller change in eGFR (beta=-16.18; p=0.001). There were no significant differences in the risk of disease recurrence (hazard ratio [HR]=0.72; p=0.61), new LR (HR=1.51; p=0.59), and distant metastasis (HR=0.19; p=0.09). Limitations include the sample size and unmeasured confounding factors.
CONCLUSIONS
CONCLUSIONS
Our results suggest that PCA provides comparable oncological outcomes to repeat surgery with fewer complications and better renal function preservation for the management of an LR after PN.
PATIENT SUMMARY
RESULTS
This report shows that percutaneous ablation can be used for treating a local recurrence of renal cell carcinoma after partial nephrectomy, without significantly compromising cancer control.
Identifiants
pubmed: 33622625
pii: S2405-4569(21)00050-X
doi: 10.1016/j.euf.2021.02.007
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
210-216Informations de copyright
Copyright © 2021 European Association of Urology. Published by Elsevier B.V. All rights reserved.