The impact of histology and type of energy used on oncological outcomes after local tumor ablation of small renal masses

You have accessJournal of UrologyCME1 Apr 2023MP58-05 THE IMPACT OF HISTOLOGY AND TYPE OF ENERGY USED ON ONCOLOGICAL OUTCOMES AFTER LOCAL TUMOR ABLATION OF SMALL RENAL MASSES Pietro Piazza, Lorenzo Bianchi, Stefano Luzzago, Marco Bandini, Angelo Mottaran, Sasan Amirhassankhani, Stefano Puliatti, Bernardino De Concilio, Antonio Celia, Carla Serra, Alberta Cappelli, Francesco Modestino, Antonio De Cinque, Rita Golfieri, Gennaro Musi, Andrea Gallina, Lugano, Switzerland, Francesco De Cobelli, Giovanni Mauri, Franco Orsi, Umberto Capitanio, Riccardo Schiavina, Ottavio De Cobelli, Francesco Montorsi, and Eugenio Brunocilla Pietro PiazzaPietro Piazza More articles by this author , Lorenzo BianchiLorenzo Bianchi More articles by this author , Stefano LuzzagoStefano Luzzago More articles by this author , Marco BandiniMarco Bandini More articles by this author , Angelo MottaranAngelo Mottaran More articles by this author , Sasan AmirhassankhaniSasan Amirhassankhani More articles by this author , Stefano PuliattiStefano Puliatti More articles by this author , Bernardino De ConcilioBernardino De Concilio More articles by this author , Antonio CeliaAntonio Celia More articles by this author , Carla SerraCarla Serra More articles by this author , Alberta CappelliAlberta Cappelli More articles by this author , Francesco ModestinoFrancesco Modestino More articles by this author , Antonio De CinqueAntonio De Cinque More articles by this author , Rita GolfieriRita Golfieri More articles by this author , Gennaro MusiGennaro Musi More articles by this author , Andrea GallinaAndrea Gallina More articles by this author , Lugano Lugano More articles by this author , Switzerland Switzerland More articles by this author , Francesco De CobelliFrancesco De Cobelli More articles by this author , Giovanni MauriGiovanni Mauri More articles by this author , Franco OrsiFranco Orsi More articles by this author , Umberto CapitanioUmberto Capitanio More articles by this author , Riccardo SchiavinaRiccardo Schiavina More articles by this author , Ottavio De CobelliOttavio De Cobelli More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , and Eugenio BrunocillaEugenio Brunocilla More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003311.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The objective of this study was to evaluate the impact of the histology at pre-procedure biopsy and the type of energy used for local tumor ablation (LTA, including Radiofrequency ablation [RFA], Cryoablation [Cryo], Microwave ablation [MW]) on long-term oncologic outcomes in patients with cT1a renal masses. METHODS: We retrospectively evaluated 650 patients treated with LTA for cT1a renal tumors at 4 European tertiary centers. Patients lost to follow-up were excluded from the analysis, leading to a final population of 574 patients. Individuals with cT1a renal mass unfit for surgery were primary scheduled for LTA in each center. Before LTA a percutaneous biopsy of the renal mass was performed to achieve the histology of the tumor. Patients were treated with percutaneous RFA, Cryo or MW according to the technique available in each center. Outcome of interest were followings: recurrence free survival (R-FS) and cancer specific mortality-free survival (CSM-FS) in patients with malign histology. Kaplan-Meier curves were used to investigate 5-years RFS and CSM-FS according to the histology at biopsy and the technique used for ablation. Multivariable Cox’s proportional hazard regressions were performed to identify predictors of R-FS. RESULTS: Overall, 197 (34%), 241 (42%) and 136 (24%) patients were treated with RFA, Cryo and MW, respectively. Median age at treatment was 68 years (IQR 60-76). Overall, 350 (60%) patients had ASA score ≥3. Median tumor size was 2.2 (IQR 1.7-3) cm. At biopsy, 330 (57%), 86 (15%), 9 (1,6%), 87 (15%), 9 (1.6%), 6 (1%) and 47 (8.2%) tumors were clear cell carcinoma, papillary, chromophobe, oncocytoma, angiomyolipoma, mixed tumors and non-diagnostic, respectively. All the procedures were complete, with no sign of residual tumor at the 24 hours imaging. During a median follow-up of 60 months (IQR 35-87), 67 (12%) patients experienced local recurrence, while 20 patients (3.5%) experienced systemic recurrence. The 5-years R-FS was 65%, 88% and 82% (p<0.001) and the 5-years CSM-FS was 96%, 94% and 98% (p=0.8) for patients treated with RFA, Cryo and MW, respectively; according to the histology, the 5-years R-FS was 73%, 89%, 74%, 62%, 96% (p=0.003) and the 5-ys CSM-FS was 94%, 100%, 100%, 100%, 100% (p=0.19) for clear cell carcinoma, papillary, chromophobe, mixed tumors and non-diagnostic histology, respectively. At multivariable analysis, clinical size (HR 1.51, CI 1.17-1.95, p=0.001), papillary histology (HR 0.27, CI 0.09-0.64, p=0.007) and MW ablation (HR 0.45, CI 0.22-0.88, p=0.02) were independent predictors of R-FS. CONCLUSIONS: Percutaneous LTA is a safe and effective approach to small renal masses in patients unfit for surgery. MW ablation, smaller clinical size and papillary histology are associated with lower risk of recurrence at 5-year. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e796 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Pietro Piazza More articles by this author Lorenzo Bianchi More articles by this author Stefano Luzzago More articles by this author Marco Bandini More articles by this author Angelo Mottaran More articles by this author Sasan Amirhassankhani More articles by this author Stefano Puliatti More articles by this author Bernardino De Concilio More articles by this author Antonio Celia More articles by this author Carla Serra More articles by this author Alberta Cappelli More articles by this author Francesco Modestino More articles by this author Antonio De Cinque More articles by this author Rita Golfieri More articles by this author Gennaro Musi More articles by this author Andrea Gallina More articles by this author Lugano More articles by this author Switzerland More articles by this author Francesco De Cobelli More articles by this author Giovanni Mauri More articles by this author Franco Orsi More articles by this author Umberto Capitanio More articles by this author Riccardo Schiavina More articles by this author Ottavio De Cobelli More articles by this author Francesco Montorsi More articles by this author Eugenio Brunocilla More articles by this author Expand All Advertisement PDF downloadLoading ...