title: A systematic review of the quality of evidence of ablative therapy for small renal masses.
abstract: OBJECTIVE
  We critically assessed the methodological and reporting quality of published studies of ablative techniques for small renal masses.
  
  
  METHODS
  We performed a systematic PubMed® and EMBASE® literature search from January 1966 to March 2010 to identify all full text, original research publications on ablative therapy for renal masses. Six reviewers working independently in 3 teams performed duplicate data abstraction using Strengthening the Reporting of Observational Studies in Epidemiology criteria, which were pilot tested in a separate sample.
  
  
  RESULTS
  A total of 117 original research publications published in a 15-year period (1995 to 2009) met eligibility criteria. No randomized, controlled trials were identified. All studies were observational and 88.9% had 1 arm with no comparison group. Median sample size was 18 patients (IQR 5.5, 40.0) and 53.8% of studies included 20 or fewer patients. Median followup was 14.0 months (IQR 8.0, 23.8) and only 19.7% of studies had an average followup of greater than 24 months. Of the studies 20.5% mentioned the number of operators involved and only 6.0% provided information on their experience level. Of the studies 66.7% addressed the recurrence rate. Disease specific and overall survival was reported in only 15.4% and 16.2% of studies, respectively.
  
  
  CONCLUSIONS
  The published literature on the therapeutic efficacy of ablative therapy for renal masses is largely limited to uncontrolled, 1-arm observational studies. In the absence of higher quality evidence ablative therapy outside research studies should be limited to select patients who are not candidates for surgical intervention.
authors.affiliation: Department of Urology, College of Medicine, University of Florida, Gainesville, Florida 32610-0247, USA.
authors.forename: Diana C
authors.initials: DC
authors.lastname: Kang
authors.forename: Drew A
authors.initials: DA
authors.lastname: Palmer
authors.forename: Mina
authors.initials: M
authors.lastname: Zarei
authors.forename: Phalgoon
authors.initials: P
authors.lastname: Shah
authors.forename: Craig
authors.initials: C
authors.lastname: Folsom
authors.forename: Rebecca J
authors.initials: RJ
authors.lastname: Beyth
authors.forename: Taryn L
authors.initials: TL
authors.lastname: Stoffs
authors.forename: Molly M
authors.initials: MM
authors.lastname: Neuberger
authors.forename: Philipp
authors.initials: P
authors.lastname: Dahm
mesh_terms: D055011:Ablation Techniques; D019317:Evidence-Based Medicine / Q000592:standards*; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*