Guidelines for management of small renal masses questioned

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By Nikki Withers, medwireNews Reporter

Partial nephrectomy (PN) and percutaneous ablation for small and localised renal masses produce similar rates of local tumour recurrence, report US researchers.

They say these data suggest there should be an update to the American Urological Association’s guidelines for renal masses, which recommends that PN should be strongly considered for healthy patients with cT1a renal masses and should be discussed as an alternate standard for cT1b patients.

Led by Robert Houston Thompson (Mayo Clinic, Rochester, Minnesota, USA) the group compared local recurrence-free, metastases-free, and overall survival among patients treated with PN, percutaneous radiofrequency ablation (RFA), and percutaneous cryoablation for sporadic and localised solid renal masses.

Of the 1803 patients included in the study, 1424 had cT1a tumours and 379 had cT1b tumours.

For patients with cT1a renal masses, 1057 underwent PN, 180 underwent RFA, and 187 underwent cryoablation.

The researchers observed that recurrence-free survival was similar among the three treatment groups at 3 years, whereas metastases-free survival was inferior for RFA compared with the other treatments, and overall survival was superior for PN.

Of the cT1b patients, 326 underwent PN and 53 patients were managed with cryoablation. Eight patients underwent RFA but were excluded from the final analysis.

The researchers found that recurrence-free survival and metastases-free survival were similar for PN and cryoablation patients, while overall survival again favoured PN patients. However Thompson et al note that this is likely reflective of selection bias.

“To our knowledge, these results represent the first comparison of oncologic outcomes among PN, percutaneous RFA, and percutaneous cryoablation patients at a single center with extensive experience in each technique”, they write in European Urology.

“In a large cohort of sporadic cT1 renal masses, we observed that recurrence-free survival was similar for PN and percutaneous ablation patients.”

The team concludes: “If validated, these data suggest that an update to clinical guidelines would be warranted.”

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