Palumbo Carlotta, Mistretta Francesco A, Knipper Sophie, Mazzone Elio, Pecoraro Angela, Tian Zhe, Perrotte Paul, Antonelli Alessandro, Montorsi Francesco, Shariat Shahrokh F, Saad Fred, Simeone Claudio, Briganti Alberto, Lavallee Luke T, Karakiewicz Pierre I
Unit of Cancer Prognostics and Health Outcomes, University of Montreal Health Center, Montreal, QB, Canada -
Unit of Urology, Department of Medical and Surgical Specialties, Radiological Science and Public Health, ASST Spedali Civili of Brescia, University of Brescia, Brescia, Italy -
Minerva Urol Nefrol. 2020 Jun;72(3):350-359. doi: 10.23736/S0393-2249.19.03496-9. Epub 2019 Sep 4.
Local tumor ablation (LTA) and non-interventional management (NIM) emerged as alternative management options for T1a renal cell carcinoma (RCC). We investigated trends and cancer-specific mortality (CSM) after LTA and NIM, compared to partial nephrectomy (PN).
Within the Surveillance, Epidemiology, and End Results database (2004-2015), T1a RCC patients treated with PN, LTA or NIM were identified. Estimated annual proportion change methodology (EAPC), 1:1 ratio propensity score (PS) matching, cumulative incidence plots and multivariable competing risks regression models (CRR) were used to compare LTA vs. PN and NIM vs. PN. Subgroup analyses focused on patients <65 and ≥65 years.
Overall 4524 patients underwent LTA vs. 1654 NIM vs. 25,435 PN. Annuals rates increased for NIM (EAPC: +3.3%, P<0.001), but not for either LTA or PN. After PS-matching in multivariable CCR, LTA (HR 1.9, P<0.001) and NIM (HR 3.0, P<0.001) showed worse 5-year CSM, relative to PN. In subgroup analyses, LTA showed no CSM disadvantage relative to PN in younger patients (HR 2.0, P=0.07). In older patients 1.64-fold CSM increase was recorded. Conversely, NIM younger (HR 3.1, P=0.001) and older (HR 3.1, P<0.001) patients exhibited higher CSM relative to PN.
In T1a RCC patients, NIM rates showed a modest but significant increase, while LTA and PN rates remained stable. In survival analyses, LTA exhibited higher CSM rates only for elderly patients. Conversely, NIM exhibited higher CSM rates in both younger and older patients.
局部肿瘤消融（LTA）和非介入性管理（NIM）成为T1a期肾细胞癌（RCC）的替代管理方案。我们研究了LTA和NIM后的趋势及癌症特异性死亡率（CSM），并与部分肾切除术（PN）进行比较。
在监测、流行病学和最终结果数据库（2004 - 2015年）中，确定接受PN、LTA或NIM治疗的T1a期RCC患者。采用估计年度比例变化方法（EAPC）、1:1比例倾向评分（PS）匹配、累积发病率图和多变量竞争风险回归模型（CRR）来比较LTA与PN以及NIM与PN。亚组分析聚焦于年龄＜65岁和≥65岁的患者。
总体而言，4524例患者接受了LTA，1654例接受了NIM，25435例接受了PN。NIM的年发生率有所增加（EAPC：+3.3%，P＜0.001），但LTA和PN的年发生率均未增加。在多变量CCR中进行PS匹配后，与PN相比，LTA（HR 1.9，P＜0.001）和NIM（HR 3.0，P＜0.001）的5年CSM更高。在亚组分析中，LTA在年轻患者中与PN相比未显示出CSM劣势（HR 2.0，P = 0.07）。在老年患者中，CSM增加了1.64倍。相反，NIM的年轻（HR 3.1，P = 0.001）和老年（HR 3.1，P＜0.001）患者与PN相比表现出更高的CSM。
在T1a期RCC患者中，NIM的发生率有适度但显著的增加，而LTA和PN的发生率保持稳定。在生存分析中，LTA仅在老年患者中表现出更高的CSM发生率。相反，NIM在年轻和老年患者中均表现出更高的CSM发生率。
