Radiofrequency ablation versus radical nephrectomy: clinical outcomes for stage T1b renal cell carcinoma.
OBJECTIVE
To compare clinical outcomes of radiofrequency (RF) ablation retrospectively with those after radical nephrectomy in patients with stage T1b renal cell carcinoma (RCC).


METHODS
This retrospective study was approved by the institutional review board, and the requirement to obtain written informed consent was waived. From June 2002 to March 2012, 60 patients (mean age, 65.2 years; age range, 39-86 years) with a single RCC measuring 4.1-7.0 cm (stage T1b) underwent RF ablation (n = 21) or radical nephrectomy (n = 39). Selective renal artery embolization was performed before RF ablation in eight patients. The overall, RCC-related, and disease-free survival rates, the percentage decrease in the glomerular filtration rate (GFR), and safety were compared by using the log-rank (survival), paired and Student t (GFR), and Fisher exact (safety) tests.


RESULTS
The overall survival rate was significantly lower in the RF ablation group than in the radical nephrectomy group (48% vs 97% at 10 years, respectively; 95% confidence interval [CI]: 12.4%, 76.7% vs 78.2%, 99.5%; P < .009). The RCC-related survival rate (94% [95% CI: 62.6%, 99.1%] with RF ablation vs 100% with radical nephrectomy at 10 years) and the disease-free survival rate (88% [95% CI: 59.2%, 96.9%] with RF ablation vs 84% [95% CI: 60.6%, 94.3%] with radical nephrectomy at 10 years, P = .99) were comparable between the two groups. No treatment-related deaths occurred. Although major complication rates were similar between the two patient groups (8.0% [two of 25 patients] vs 5.1% [two of 39 patients], P = .61), the percentage decrease in the GFR was significantly lower in the RF ablation group than in the radical nephrectomy group at the last follow-up (12.5% ± 23.4 vs 32.3% ± 20.8, respectively; P < .003).


CONCLUSIONS
RF ablation is a safe procedure for patients at substantial surgical risk for radical nephrectomy, providing comparable RCC-related and disease-free survival and preserving renal function.
From the Departments of Radiology (H.T., A.N., J.U., M.F., T.Y., T.H., H.S., K.Y.) and Nephro-Urologic Surgery and Andrology (H.K., K.A., Y.S.), Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan; and Division of Urology, Aichi Cancer Center Hospital, Nagoya, Aichi, Japan (N.S.).
Haruyuki
H
Takaki
Norihito
N
Soga
Hideki
H
Kanda
Atsuhiro
A
Nakatsuka
Junji
J
Uraki
Masashi
M
Fujimori
Takashi
T
Yamanaka
Takaaki
T
Hasegawa
Kiminobu
K
Arima
Yoshiki
Y
Sugimura
Hajime
H
Sakuma
Koichiro
K
Yamakado
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000473:pathology / Q000601:surgery*; D017115:Catheter Ablation; D004621:Embolization, Therapeutic; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000379:methods*; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome