Effectiveness of Radiofrequency ablation for Biopsy proven T1a renal cell carcinoma (RCC)m greater than or equal to 3 cm.

The American urological association recommends ablation as an alternative treatment option for T1a RCC only when they are 3 cm or less in size. The purpose of this study is to evaluate the outcomes of radiofrequency ablation (RFA) for Biopsy proven T1a RCC greater than or equal to 3 cm.

 

Materials and Methods:

We retrospectively reviewed our institutional renal ablation registry.  We only included patients with solitary denovo biopsy proven T1a RCC greater than or equal to 3 cm who underwent RFA between January 2001 until December 2020. Using propensity score matching, patients with lesion sizes greater than or equal to 3 cm (Group A) were matched with an equal number of patients with lesions Less than 3 cm (Group B) based upon the pathology, grade, duration of Follow-Up, another Primary malignancy, age and sex. We collected demographics, tumor size, histology, complications, local recurrence at ablation site, development of metastases, history of another malignancy, survival/death and cause of death. OS, RFS, MFS, DFS and CSS were estimated using Kaplan and Meier product-limit estimator and compared the outcomes and survival rates of both groups.

 

Results:

One hundred twenty-two patients (84 male and 38 female, median age 68.7 years) were included in the matched analyses (61 patients in each group). Of these, a total of 8 were missing data on disease recurrence, leaving 114 patients with data on RFS, DFS (55 patients in group A and, 59 patients in Group B). The median tumor size in group A and group B was 3.3 cm and 2.2 cm respectively. There was no statistically significant difference in the complication rate (p=0.11), local recurrence at the ablation site (P=0.15) between both groups. None of patients in either group developed metastasis from RCC. Sixty-seven (55 %) patients had another primary cancer; 32 and 35 patients in groups A and B respectively (p=0.917). There was no statistically significant difference in 5- and 10- overall survival (p= 0.93), recurrence free survival (p= 0.45) and disease-free survival (p=0.37) between both groups. The metastasis free survival (MFS) and cancer specific survival (CSS) were 100% in both groups.

 

Conclusion:

Radiofrequency ablation is a highly effective modality for treatment of T1a RCC greater than or equal to 3 cm. Long term data reveals favorable oncologic control and survival outcome comparable to those of lesions less than 3 cm