Population-based utilization and survival of competing treatments for small renal masses: The growing role of thermal ablation.
Academic Article
Overview
abstract
BACKGROUND: Thermal ablation has emerged as a minimally-invasive alternative to surgery for select patients with clinical T1a Renal Cell Carcinoma (RCC). METHODS: Using the Survival, Epidemiology and End Results (SEER) database (2004-2022), we identified patients with T1a RCC who underwent thermal ablation, partial nephrectomy, radical nephrectomy, or observation. Baseline characteristics were compared using chi-squared and t-tests or Wilcoxon rank-sum tests. Multivariable logistic regression identified factors associated with thermal ablation use. Kaplan-Meier and Cox regression analyses evaluated cancer-specific survival and overall survival. RESULTS: Among 73,143 patients, thermal ablation utilization increased from 3.2% to 13% while RN decreased from 56% to 19%. Older age, smaller tumors, and later year of diagnosis were associated with thermal ablation use. African-American race, female sex, and chromophobe histology were associated with lower use of thermal ablation. At 10 years, cancer-specific survival was higher for surgery and thermal ablation than for observation (97%, 96%, 82%, respectively, P < 0.0001). CONCLUSION: Thermal ablation use for clinical stage T1a RCC has increased substantially, particularly among older patients with smaller tumors. Cancer-specific survival is similar between thermal ablation and surgery despite selection of higher-risk patients for thermal ablation, indicated by significantly worse overall survival. Findings support thermal ablation as an option for select patients, while highlighting disparities and the need for further study of long-term outcomes across thermal ablation modalities.
