Ablation versus Resection for Stage 1A Renal Cell Carcinoma: National Variation in Clinical Management and Selected Outcomes.
Radiology. 2018 Sep;288(3):889-897. doi: 10.1148/radiol.2018172960. Epub 2018 Jul 3.
Uhlig J1, Kokabi N1, Xing M1, Kim HS1.
Purpose To compare patients in a national U.S. database who underwent thermal ablation or nephrectomy for renal cell carcinoma (RCC) in terms of demographic differences, perioperative outcomes, and survival. Materials and Methods This National Cancer Database study included patients who underwent thermal ablation or nephrectomy for biopsy-proven T1aN0M0 RCC between 2004 and 2013. Demographic factors were analyzed as treatment predictors. Unplanned hospital readmission, mean hospital stay, 30- and 90-day postoperative mortality, and survival were analyzed in a propensity score-matched cohort by using χ2 tests, Cox proportional hazards models, and Renyi family tests. Results Included were 4817 of 56 065 patients (8.6%) who underwent thermal ablation and 51 248 of 56 065 patients (91.4%) who underwent nephrectomy. Patients who underwent thermal ablation skewed older (mean, 52 years vs 44 years, respectively) with more comorbidities (9% vs 7.6% Charlson Comorbidity Index score of ≥2, respectively). Male sex, white race, nonprivate insurance, therapy at academic centers, and south Atlantic state urban residence with lower income and education were associated with higher thermal ablation treatment likelihood (P < .001). After matching, perioperative outcomes were superior for thermal ablation: unplanned hospital readmission, mean hospital stay, and 30- and 90-day postoperative mortality were lower for thermal ablation (2% vs 3.3%, 1.3 days vs 4.3 days, 0% vs 0.9%, and 0% vs 1.4%, respectively; each P < .001). Survival was comparable for thermal ablation and nephrectomy in patients older than 65 years, and during the 1st postoperative year for all patients. Conclusion Thermal ablation for RCC varied by national region and with multiple clinical and nonclinical demographic factors. Thermal ablation demonstrates superior perioperative outcomes with short mean hospital stay, low unplanned hospital readmission, and 30- and 90-day mortality. In selected patients, thermal ablation survival may be comparable to nephrectomy.