To compare the oncological outcomes of percutaneous cryoablation (PCA) versus robot-assisted partial nephrectomy (RPN) for the treatment of T1 renal tumors.
We included retrospectively all patients treated by RPN or PCA for malignant renal tumor in 4 centres between 2009 and 2016. Tumors were paired one by one using radiological tumor stage and RENAL score (package matchit, R software version 3.2.2). Malignancy was confirmed using biopsy for all patients in the PCA group. The characteristics of the patients before and after the match and the oncological results were compared between the two groups. Cox regression adjusted for age, treatment type, histological type and margins was used to identify factors associated with time to local recurrence. Positive margins were defined histologically in the RPN group and radiologically in the PCA group.
647 patients were identified, 470 RPN and 177 PCA. After matching, there was no significant difference between the two groups (177 RPN and 177 PCA) for tumor stage, RENAL score, tumor size (27.6 vs 25.9, p = 0.07), and gender ratio. Patient in the PCA group remained significantly older (69.9 vs 59.8 years, p <0.001). The absolute recurrence rate was 2.8% in the RPN group vs 8.4% in the PCA group (p = 0.03). 5 years recurrence free survival was 85% in the PCA group vs 95% in the RPN group (log rank p = 0.02, Figure). In multivariate analysis, the presence of positive margins and the type of treatment were the two factors significantly associated with local recurrence (p <0.0001 and p = 0.0455 respectively).
The local recurrence rate after PCA was significantly higher than after RPN for T1 renal tumor. Incomplete treatment was the main criterion associated with recurrence. The recurrence rate may be overestimated in the PCA group due to closer radiological follow-up. This article is protected by copyright. All rights reserved.
BJU international. 2018 Aug 28 [Epub ahead of print]
G Fraisse, L Colleter, B Peyronnet, Z Khene, Q Mandoorah, Y Soorojebally, A Bourgi, A De La Taille, M Roupret, E De Kerviler, F Desgrandchamps, K Bensalah, A Masson-Lecomte
Urology department, Saint Louis Academic Hospital Paris Diderot Université, Paris, France., Radiology Department, Saint Louis Academic Hospital Paris Diderot Université Paris, France., Urology department, Rennes Academic Hospital, Rennes, France., Sorbonne Université, GRC n°5, ONCOTYPE-URO, AP-HP, Hôpital Pitié-Salpêtrière, F-75013, Paris, France., Urology department, Henri Mondor Academic Hospital, Créteil, France.