Urology · 2025
Long-term Outcomes of Partial Nephrectomy Versus Percutaneous Ablation for Renal Cell Carcinoma: A Propensity-Matched Analysis.
Сравнительное исследованиеСтатьяМногоцентровое исследованиеНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
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Stamper Madison, Collins Jennifer, Arellano Ronald S, DeSanto Matthew, Deem Samuel, Annie Frank, Deipolyi Amy R
Аннотация
OBJECTIVE: To compare peri-procedural outcomes and long-term (10-year) survival, metastasis risk, and reintervention rates between partial nephrectomy versus image-guided ablation (cryoablation and heat-based ablation) for renal cell carcinoma (RCC).
MATERIALS AND METHODS: This Institutional Review Board-approved, retrospective cohort study utilized TriNetX (TriNetX LLC, Cambridge, MA), a multi-institution database of deidentified electronic medical records. Adult patients with RCC who underwent partial nephrectomy, cryoablation, or heat-based thermal ablation 2004-2025 were identified. Propensity score matching (PSM) was used to balance cohorts for age, comorbidities, renal function, and BMI. Outcomes included post-procedural complications, hospital stay, need for additional renal interventions, survival, and treatment of metastatic disease. Statistical analyses included Kaplan-Meier survival curves and chi-square tests for categorical variables.
RESULTS: A total of 9374 partial nephrectomy, 2169 cryoablation, and 1003 heat-based ablation patients were included. After PSM, partial nephrectomy was associated with longer hospital stays (1.2 vs 0.4 days for cryoablation and 0.3 days for heat-based ablation; P<.01), increased intensive care unit admissions (4.0% vs 1.4% and 1.0%; P<.01), and higher blood transfusion rates (4.3% vs 1.4% and 0.9%; P<.01). However, ablation was associated with increased reintervention rates at 10 years (cryoablation: 13.0%; heat-based ablation: 9.6%) compared to partial nephrectomy (1.3%; P<.01). Ten-year survival rates were similar across groups (partial nephrectomy: 89.4%, cryoablation: 89.2%, heat-based ablation: 87.8%; P>.05).
CONCLUSION: Partial nephrectomy and percutaneous ablation demonstrate comparable 10-year survival and metastasis rates for RCC. Ablation confers lower procedural morbidity but higher reintervention rates. Findings support patient-specific treatment selection considering comorbidities and procedural risks.
MATERIALS AND METHODS: This Institutional Review Board-approved, retrospective cohort study utilized TriNetX (TriNetX LLC, Cambridge, MA), a multi-institution database of deidentified electronic medical records. Adult patients with RCC who underwent partial nephrectomy, cryoablation, or heat-based thermal ablation 2004-2025 were identified. Propensity score matching (PSM) was used to balance cohorts for age, comorbidities, renal function, and BMI. Outcomes included post-procedural complications, hospital stay, need for additional renal interventions, survival, and treatment of metastatic disease. Statistical analyses included Kaplan-Meier survival curves and chi-square tests for categorical variables.
RESULTS: A total of 9374 partial nephrectomy, 2169 cryoablation, and 1003 heat-based ablation patients were included. After PSM, partial nephrectomy was associated with longer hospital stays (1.2 vs 0.4 days for cryoablation and 0.3 days for heat-based ablation; P<.01), increased intensive care unit admissions (4.0% vs 1.4% and 1.0%; P<.01), and higher blood transfusion rates (4.3% vs 1.4% and 0.9%; P<.01). However, ablation was associated with increased reintervention rates at 10 years (cryoablation: 13.0%; heat-based ablation: 9.6%) compared to partial nephrectomy (1.3%; P<.01). Ten-year survival rates were similar across groups (partial nephrectomy: 89.4%, cryoablation: 89.2%, heat-based ablation: 87.8%; P>.05).
CONCLUSION: Partial nephrectomy and percutaneous ablation demonstrate comparable 10-year survival and metastasis rates for RCC. Ablation confers lower procedural morbidity but higher reintervention rates. Findings support patient-specific treatment selection considering comorbidities and procedural risks.