Limitations of Available Studies Prevent Reliable Comparison Between Tumour Ablation and Partial Nephrectomy for Patients with Localised Renal Masses: A Systematic Review from the European Association of Urology Renal Cell Cancer Guideline Panel.

The European Association of Urology (EAU) Renal Cell Carcinoma (RCC) Guideline Panel performed a protocol-driven systematic review (SR) on thermal ablation (TA) compared with partial nephrectomy (PN) for T1N0M0 renal masses, in order to provide evidence to support its recommendations. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed, and only comparative studies published between 2000 and 2019 were included. Twenty-six nonrandomised comparative studies were included, recruiting a total of 167 80 patients. Risk of bias (RoB) assessment revealed high or uncertain RoB across all studies, with the vast majority being retrospective, observational studies with poorly matched controls and short follow-up. Limited data showed TA to be safe, but its long-term oncological effectiveness compared with PN remains uncertain. A quality assessment of pre-existing SRs (n=11) on the topic, using AMSTAR, revealed that all SRs had low confidence rating, with all but two SRs being rated critically low. In conclusion, the current data are inadequate to make any strong and clear conclusions regarding the clinical effectiveness of TA for treating T1N0M0 renal masses compared with PN. Therefore, TA may be cautiously considered an alternative to PN for T1N0M0 renal masses, but patients must be counselled carefully regarding the prevailing uncertainties. We recommend specific steps to improve the evidence base based on robust primary and secondary studies. PATIENT SUMMARY: In this report, we looked at the literature to determine the effectiveness of thermoablation (TA) in the treatment of small kidney tumours compared with surgical removal. We found that TA could cautiously be offered as an option due to many remaining uncertainties regarding its effectiveness.

European urology oncology. 2020 Mar 31 [Epub ahead of print]

Yasmin Abu-Ghanem, Sergio Fernández-Pello, Axel Bex, Börje Ljungberg, Laurence Albiges, Saeed Dabestani, Rachel H Giles, Fabian Hofmann, Milan Hora, Markus A Kuczyk, Teele Kuusk, Lorenzo Marconi, Axel S Merseburger, Rana Tahbaz, Michael Staehler, Alessandro Volpe, Thomas Powles, Thomas B Lam, Karim Bensalah

Department of Urology, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel., Department of Urology, Cabueñes Hospital, Gijón, Spain., The Royal Free London NHS Foundation Trust and UCL Division of Surgery and Interventional Science, London, UK; Department of Urology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands., Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden., Department of Cancer Medicine, Institut Gustave Roussy, Villejuif, France., Department of Urology, Skåne University Hospital, Malmö, Sweden., Department of Nephrology and Hypertension, Patient Advocate International Kidney Cancer Coalition (IKCC), University Medical Center Utrecht, Utrecht, The Netherlands., Department of Urology, Sunderby Hospital, Sunderby, Sweden., Department of Urology, Faculty Hospital and Faculty of Medicine in Pilsen, Charles University in Prague, Prague, Czech Republic., Department of Urology and Urologic Oncology, Hannover Medical School, Hannover, Germany., Department of Urology, Royal Free Hospital, London, UK., Department of Urology, Coimbra University Hospital, Coimbra, Portugal., Department of Urology, University Hospital Schleswig-Holstein, Lübeck, Germany., Department of Urology, Elbe Kliniken Stade, Stade, Germany., Department of Urology, Ludwig-Maximilians University, Munich, Germany., Division of Urology, Maggiore della Carita Hospital, University of Eastern Piedmont, Novara, Italy., The Royal Free NHS Trust and Barts Cancer Institute, Queen Mary University of London, London, UK; Academic Urology Unit, University of Aberdeen, Aberdeen, UK., Department of Urology, University of Rennes, Rennes, France. Electronic address: .