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Systematic Review and Meta-Analysis of Thermal Ablation Versus Surgical Nephrectomy for Small Renal Tumours

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Abstract

Purpose

A systematic review was undertaken to provide a meta-analysis of clinical trials comparing thermal ablation with surgical nephrectomy for small renal tumours.

Methods

PubMed (MEDLINE), EMBASE, AMED, and Scopus were searched in August 2013 for eligible prospective or retrospective comparative trials following the PRISMA selection process. Thermal ablation was compared with surgical nephrectomy. Quality of included studies was assessed on the Newcastle-Ottawa Scale (NOS). The primary endpoint was disease-free survival and was analyzed on the log-hazard scale. Secondary outcome measures included complications, local recurrence, and decline of renal function. Hazard ratios (HR) and risk ratios (RR) were calculated with a random effects model, and meta-regression analysis was performed to explore clinical heterogeneity.

Results

Six clinical trials (1 randomized and 5 cohort; 6–8 stars on the NOS scale) involving 587 patients with small renal tumors (mean size 2.5 cm) treated with either thermal ablation (percutaneous or laparoscopic application of radiofrequency or microwave) or surgical nephrectomy (open or laparoscopic) were analyzed. Overall complication rate was significantly lower in the ablation group (7.4 vs. 11 %; RR: 0.55, 95 % confidence interval [CI]: 0.31–0.97, p = 0.04). Postoperative decline of eGFR was higher in case of nephrectomy (mean difference: −14.6 ml/min/1.73 m2, 95 % CI: −27.96 to −1.23, p = 0.03). Local recurrence rate was the same in both groups (3.6 vs. 3.6 %; RR: 0.92, 95 % CI: 0.4–2.14, p = 0.79) and disease-free survival also was similar up to 5 years (HR: 1.04, 95 % CI: 0.48–2.24, p = 0.92).

Conclusions

Thermal ablation of small renal masses produces oncologic outcomes similar to surgical nephrectomy and is associated with significantly lower overall complication rates and a significantly less decline of renal function. More randomized, controlled trials are necessary.

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Abbreviations

RCC:

Renal cell carcinoma

RFA:

Radiofrequency ablation

MWA:

Microwave ablation

RCT:

Randomized controlled Trial

PN:

Partial nephrectomy

CT:

Computed tomography

MRI:

Magnetic resonance imaging

eGFR:

Estimated glomerular filtration rate

DFS:

Disease-free survival

HR:

Hazard ratio

RR:

Risk ratio

CI:

Confidence interval

M–H:

Mantel–Haenszel

D-L:

DerSimonian and Laird

NOS:

Newcastle-Ottawa scale

PRISMA:

Preferred Reporting Items for Systematic reviews and Meta-analyses

References

  1. Rini BI, Campbell SC, Escudier B (2009) Renal cell carcinoma. Lancet 373(9669):1119–1132

    Article  CAS  PubMed  Google Scholar 

  2. Siegel R, Naishadham D (2013) Jemal A (2013) Cancer statistics. CA Cancer J Clin 63(1):11–30

    Article  PubMed  Google Scholar 

  3. Escudier B, Eisen T, Porta C et al (2012) Renal cell carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 23(Suppl 7):65–71

    Article  Google Scholar 

  4. MacLennan S, Imamura M, Lapitan MC et al (2012) Systematic review of oncological outcomes following surgical management of localised renal cancer. Eur Urol 61(5):972–993

    Article  PubMed  Google Scholar 

  5. Whitson JM, Harris CR, Meng MV (2012) Population-based comparative effectiveness of nephron-sparing surgery vs ablation for small renal masses. BJU Int 110(10):1438–1443 discussion 1443

    Article  PubMed  Google Scholar 

  6. Kang DC, Palmer DA, Zarei M et al (2012) A systematic review of the quality of evidence of ablative therapy for small renal masses. J Urol 187(1):44–47

    Article  PubMed  Google Scholar 

  7. Kunkle DA, Egleston BL, Uzzo RG (2008) Excise, ablate or observe: the small renal mass dilemma—a meta-analysis and review. J Urol 179(4):1227–1233 discussion 1233-1224

    Article  PubMed  Google Scholar 

  8. Choueiri TK, Schutz FA, Hevelone ND et al (2011) Thermal ablation vs surgery for localized kidney cancer: a surveillance, epidemiology, and end results (SEER) database analysis. Urology 78(1):93–98

    Article  PubMed  Google Scholar 

  9. Klatte T, Grubmuller B, Waldert M, Weibl P, Remzi M (2011) Laparoscopic cryoablation versus partial nephrectomy for the treatment of small renal masses: systematic review and cumulative analysis of observational studies. Eur Urol 60(3):435–443

    Article  PubMed  Google Scholar 

  10. Campbell SC, Novick AC, Belldegrun A et al (2009) Guideline for management of the clinical T1 renal mass. J Urol 182(4):1271–1279

    Article  PubMed  Google Scholar 

  11. Stang A (2010) Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol 25(9):603–605

    Article  PubMed  Google Scholar 

  12. Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 339:b2535

    Article  PubMed Central  PubMed  Google Scholar 

  13. Clark TW, Millward SF, Gervais DA et al (2009) Reporting standards for percutaneous thermal ablation of renal cell carcinoma. J Vasc Interv Radiol 20(7 Suppl):S409–S416

    Article  PubMed  Google Scholar 

  14. Hirooka T, Hamada C, Yoshimura I (2009) A note on estimating treatment effect for time-to-event data in a literature-based meta-analysis. Methods Inf Med 48(2):104–112

    PubMed  Google Scholar 

  15. Parmar MK, Torri V, Stewart L (1998) Extracting summary statistics to perform meta-analyses of the published literature for survival endpoints. Stat Med 17(24):2815–2834

    Article  CAS  PubMed  Google Scholar 

  16. Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327(7414):557–560

    Article  PubMed Central  PubMed  Google Scholar 

  17. Egger M, Davey Smith G, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315(7109):629–634

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  18. Bird VG, Carey RI, Ayyathurai R, Bird VY (2009) Management of renal masses with laparoscopic-guided radiofrequency ablation versus laparoscopic partial nephrectomy. J Endourol 23(1):81–88

    Article  PubMed  Google Scholar 

  19. Guan W, Bai J, Liu J et al (2012) Microwave ablation versus partial nephrectomy for small renal tumors: intermediate-term results. J Surg Oncol 106(3):316–321

    Article  PubMed  Google Scholar 

  20. Olweny EO, Park SK, Tan YK, Best SL, Trimmer C, Cadeddu JA (2012) Radiofrequency ablation versus partial nephrectomy in patients with solitary clinical T1a renal cell carcinoma: comparable oncologic outcomes at a minimum of 5 years of follow-up. Eur Urol 61(6):1156–1161

    Article  PubMed  Google Scholar 

  21. Stern JM, Svatek R, Park S et al (2007) Intermediate comparison of partial nephrectomy and radiofrequency ablation for clinical T1a renal tumours. BJU Int 100(2):287–290

    Article  PubMed  Google Scholar 

  22. Sung HH, Park BK, Kim CK, Choi HY, Lee HM (2012) Comparison of percutaneous radiofrequency ablation and open partial nephrectomy for the treatment of size- and location-matched renal masses. Int J Hyperthermia 28(3):227–234

    Article  PubMed  Google Scholar 

  23. Takaki H, Yamakado K, Soga N et al (2010) Midterm results of radiofrequency ablation versus nephrectomy for T1a renal cell carcinoma. Jpn J Radiol 28(6):460–468

    Article  PubMed  Google Scholar 

  24. Carrafiello G, Mangini M, Fontana F et al (2010) Single-antenna microwave ablation under contrast-enhanced ultrasound guidance for treatment of small renal cell carcinoma: preliminary experience. Cardiovasc Intervent Radiol 33(2):367–374

    Article  PubMed  Google Scholar 

  25. Liang P, Wang Y, Zhang D, Yu X, Gao Y, Ni X (2008) Ultrasound guided percutaneous microwave ablation for small renal cancer: initial experience. J Urol 180(3):844–848 discussion 848

    Article  PubMed  Google Scholar 

  26. Gervais DA, Arellano RS, McGovern FJ, McDougal WS, Mueller PR (2005) Radiofrequency ablation of renal cell carcinoma: part 2, Lessons learned with ablation of 100 tumors. AJR Am J Roentgenol 185(1):72–80

    Article  PubMed  Google Scholar 

  27. Farrell MA, Charboneau WJ, DiMarco DS et al (2003) Imaging-guided radiofrequency ablation of solid renal tumors. AJR Am J Roentgenol 180(6):1509–1513

    Article  CAS  PubMed  Google Scholar 

  28. Atwell TD, Farrell MA, Leibovich BC et al (2008) Percutaneous renal cryoablation: experience treating 115 tumors. J Urol 179(6):2136–2140 discussion 2140-2131

    Article  PubMed  Google Scholar 

  29. Zagoria RJ, Traver MA, Werle DM, Perini M, Hayasaka S, Clark PE (2007) Oncologic efficacy of CT-guided percutaneous radiofrequency ablation of renal cell carcinomas. AJR Am J Roentgenol 189(2):429–436

    Article  PubMed  Google Scholar 

  30. Su L, Jarrett TW, Chan DY, Kavoussi LR, Solomon SB (2003) Percutaneous computed tomography-guided radiofrequency ablation of renal masses in high surgical risk patients: preliminary results. Urology 61(4 Suppl 1):26–33

    Article  PubMed  Google Scholar 

  31. Dominguez-Escrig JL, Sahadevan K, Johnson P (2008) Cryoablation for small renal masses. Adv Urol 479–495

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Conflict of interest

K. Katsanos, L. Mailli, M. Krokidis, A. Mcgrath, T. Sabharwal, and A. Adam report no conflict of interest in relation to this research. No conflicts of interest or relationship with the industry.

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Authors and Affiliations

  1. Department of Interventional Radiology, Guy’s and St. Thomas’ Hospitals, NHS Foundation Trust, King’s Health Partners, London, SE1 7EH, UK

    K. Katsanos, L. Mailli, A. McGrath, T. Sabharwal & A. Adam

  2. Department of Interventional Radiology, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK

    M. Krokidis

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  1. K. Katsanos
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  2. L. Mailli
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  3. M. Krokidis
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Correspondence to K. Katsanos.

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Katsanos, K., Mailli, L., Krokidis, M. et al. Systematic Review and Meta-Analysis of Thermal Ablation Versus Surgical Nephrectomy for Small Renal Tumours. Cardiovasc Intervent Radiol 37, 427–437 (2014). https://doi.org/10.1007/s00270-014-0846-9

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