Ablative Therapies for Early Stage Kidney Cancer and the Evolving Role of the Urologist.

Overview

abstract

INTRODUCTION: The modern treatment paradigms for early stage kidney cancer include ablative therapies. Unlike surgical ablation, percutaneous ablation uses a radiographic platform, potentially altering the role of the urologist. We compared surgical and percutaneous ablation regarding treatment processes and outcomes. METHODS: Using SEER (Surveillance, Epidemiology and End Results)-Medicare data, we identified subjects undergoing surgical or percutaneous ablation between 2006 and 2009 for stage I kidney cancer. We evaluated outcomes relating to 30-day complications, unplanned hospital admissions, long-term survival and mortality. Adjusting for patient characteristics, we compared processes and outcomes according to ablation approach using generalized estimating equations and Cox proportional hazard models, respectively. RESULTS: We identified 376 subjects (45.8%) treated with surgical ablation and 444 (54.1%) treated with percutaneous ablation. Use of percutaneous ablation increased substantially during the study period. Compared to surgical ablation, percutaneous ablation was applied more often in the outpatient setting (71.2% vs 2.4%, p <0.001) and following a period of surveillance (14.6% vs 6.1%, p <0.001). Subjects treated with percutaneous ablation were less likely to have preoperative, perioperative or postoperative urological involvement (p <0.001). While adverse events were more common for surgical ablation (32.7% vs 15.0%, p <0.001), unplanned hospitalizations were similar (10.2% vs 9.1%, p = 0.625), as was 30-day mortality (2.6% vs 1.1%, p = 0.127). Retreatment-free survival was significantly higher for surgical vs percutaneous ablation (HR 1.84, 95% CI 1.15-2.94). CONCLUSIONS: Percutaneous ablation has become the most common ablative modality for early stage kidney cancer. Although percutaneous ablation carries a more favorable safety profile, posttreatment morbidity occurs with some frequency, highlighting the need for continued urologist engagement.