Good Survival Rates After Percutaneous Cryoablation for Early Renal Cell Carcinoma

By Reuters Staff

June 11, 2020

NEW YORK (Reuters Health) - Percutaneous cryoablation yields survival rates at least as good as those with nephrectomy in patients with stage-1 renal-cell carcinoma (RCC), according to a prospective observational study.

National guidelines support the use of percutaneous cryoablation (PCA) for stage-1 RCC based on meta-analyses of mostly small retrospective studies.

Dr. Christos S. Georgiades of Johns Hopkins University, in Baltimore, Maryland, and colleagues evaluated the 10-year oncologic outcomes of PCA in 134 patients with stage-1 RCC and compared them with those of matched patients in the National Cancer Database (NCDB) who underwent partial (n=13,090) or radical (n=6,645) nephrectomy.

The median age in the PCA group was 68 years (range, 35-88 years), and the median tumor size was 2.8 cm (range, 0.5-7.0 cm). Most patients (86%) were stage 1A, and the rest were stage 1B, the researchers report in Radiology.

Most patients (84.6%) were discharged after a three-hour observation period, but 21 patients (15.6%) had to be admitted for either clinically significant symptoms or complications.

Overall survival for the PCA group was 87% at five years and 72% at 10 years, with recurrence-free survival of 85% and 69%, respectively, and disease-specific survival of 94% at both five and 10 years.

Results were similar in the subgroup of patients with stage-1B disease, who had 88% overall survival, 89% recurrence-free survival and 94% disease-specific survival at both five years and 10 years.

In the matched NCDB group, the five- and 10-year overall survival were 78% and 49%, respectively, following partial nephrectomy and 67% and 43%, respectively, following radical nephrectomy.

The PCA group significantly outperformed both the partial and radical nephrectomy subgroups in terms of overall survival at both the five- and 10-year marks.

During 10 years of follow-up, eight PCA patients (6%) were diagnosed with metachronous RCC after a median 48 months (range, 12-89 months), and five of 132 patients (3.8%) not on dialysis prior to PCA transitioned to hemodialysis (only three of these patients had normal serum creatinine level prior to PCA).

Dr. Georgiades did not respond to a request for comments.

SOURCE: Radiology, online June 9, 2020.