Radiofrequency ablation versus partial nephrectomy for clinical T1a renal-cell carcinoma: long-term clinical and oncologic outcomes based on a propensity score analysis.

PURPOSE

To compare outcomes in patients treated with radiofrequency ablation (RFA) and partial nephrectomy (PN) for clinical T1a renal-cell carcinoma (RCC) in a propensity-score matched cohort.

METHODS

We conducted a retrospective review of the records of all patients who underwent RFA or nephrectomy between February 2005 and December 2009 in our institution. The Kaplan-Meier method was used to generate the survival curves that were compared with the log-rank test. Univariable and multivariable regression analyses were performed to determine predictors of survival.

RESULTS

A total of 90 patients were included in the final study after being matched by propensity scores (RFA 45; PN 45). The 5-year overall survival (95% confidence interval [CI]) was 90.2% (78.6-98.8) vs 93.2% (85.8-98.9); 5-year cancer-specific survival (95% CI) was 95.6% (89.5-98.1) vs 97.7% (93.4-99.3); 5-year disease-free survival (95% CI) was 86.7% (89.5-96.7) and 88.5% (79.1-97.9); 5-year recurrence-free survival (95% CI) was 95.4% (89.3-98.1) vs 97.7% (93.3-99.2); and 5-year metastasis-free survival (95% CI) was 95.5% (89.4-98.0) vs 95.5% (89.4-98.0). Age was the only factor that could predict the disease-free survival (P=0.044). The percentage decrease in the glomerular filtration rate was significantly lower in the RFA group at the time of last follow-up (P=0.001).

CONCLUSIONS

In the propensity-score matched cohort of patients with clinical T1a RCC, we observed that RFA was an effective treatment option that provided comparable 5-year oncologic outcomes and better preservation of renal function than PN.