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Local Treatment Success of Radiofrequency Ablation: Long-Term Results from 352 Stage T1a Renal Cell Carcinomas
David Kuppermann1, Christopher B Allard1, Naren Nimmagadda1, Sarah Psutka2, Peng Wu1, Francis J McGovern1, Scott W McDougal1, Debra Gervais1, Michael L Blute1, Adam S Feldman1
1Massachusetts General Hospital, Boston, MA;2Mayo Clinic, Rochester, MN
Introduction:Radiofrequency ablation (RFA) is a minimally invasive treatment option for the management of low stage renal cell carcinoma (RCC). We present long−term local oncologic outcomes of our RFA series among patients with stage T1a RCC.
Materials & Methods:We reviewed patients who underwent percutaneous RFA for biopsy-proven unifocal stage T1a (size≤4cm N0 M0) RCC at our institution between 1998 and 2014. Patients with familial RCC syndromes or previous metastases were excluded. Cox proportional hazards regressions were employed to assess tumor (size and RENAL Nephrometry score) and patient (age, Charlson comorbidity index [CCI]) characteristics associated with local recurrence.
Results:In total, 352 patients underwent RFA and met inclusion criteria. Median age was 69 years and median tumor size 2.5cm. Post RFA residual tumor was identified in 22 (6.3%). With median follow-up 46 months (Interquartile range 24-70), 23 (6.5%) patients experienced local recurrence. Five and 7-year actuarial recurrence-free-survival were 92% and 87% respectively. In univariate analyses, neither age, tumor size, CCI, nor high RENAL scores (>9) were predictive of recurrence, although high RENAL score approached significance (hazard ratio [HR] 1.78, p=0.069) . In multivariate analysis including age, CCI, and RENAL score, the association between high RENAL score and recurrence approached significance (Hazard Ratio 1.77, p=0.070).
Conclusions:RFA provides acceptable long-term local control for appropriately selected patients with clinical stage T1a RCC.
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