Alessandro Larcher1, Nicola Fossati2, Zhe Tian3, Katharina Boehm4, Malek Meskawi5, Roger Valdivieso5, Vincent Trudeau5, Paolo Dell'Oglio6, Nicolò Buffi7, Francesco Montorsi8, Giorgio Guazzoni7, Maxine Sun9, Pierre I Karakiewicz5. 1. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada; Division of Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy. Electronic address: alelarcher@gmail.com. 2. Division of Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA. 3. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada. 4. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada; Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany. 5. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada; Department of Urology, University of Montreal Health Center, Montreal, Canada. 6. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada; Division of Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy. 7. Department of Urology, Humanitas Clinical and Research Center, Milan, Italy. 8. Division of Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy. 9. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada.
Abstract
BACKGROUND: Current guidelines recommend local tumour ablation (LTA) over partial nephrectomy (PN) in nonsurgical candidates; however, objective definitions of these candidates are lacking. OBJECTIVE: To identify specific patients who would benefit from LTA more than PN. DESIGN, SETTING, AND PARTICIPANTS: A population-based assessment was performed of 2476 patients in the Surveillance Epidemiology and End Results-Medicare database who had cT1a kidney cancer treated with either LTA or PN, between 2000 and 2009. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The outcome of the study was the relevant perioperative complications rate. A multivariable logistic regression model was fitted to predict the risk of complications after PN. Model-derived coefficients were used to calculate the risk of complication in case of PN among patients treated with LTA. Locally weighted scatterplot smoothing method was used to plot the observed complication rate against the predicted risk of complication in case of PN. RESULTS AND LIMITATIONS: At multivariable logistic regression, age (odds ratio [OR]: 1.04; p<0.001), Charlson comorbidity index (OR: 1.14; p<0.001), acute kidney injury (OR: 1.91; p=0.04), or chronic kidney disease (OR: 2.16; p=0.002), tumour size (OR: 1.02; p=0.01), and minimally invasive approach (OR: 0.77; p<0.03) emerged as significant predictors of complications. When LTA was chosen over PN, the reduction in the risk of complications was greatest in high-risk patients, intermediate in intermediate-risk patients, and least in low-risk patients. CONCLUSIONS: When postoperative complications are evaluated, the benefit of choosing LTA is not the same in all patients diagnosed with T1a kidney cancer. Specifically, patients at high risk of complications in case of PN may benefit the most from LTA and represent ideal LTA candidates. PATIENT SUMMARY: Elderly patients at high risk of complications in case of surgical treatment with partial nephrectomy for kidney cancer should be instructed that local tumour ablation might decrease their perioperative morbidity.
BACKGROUND: Current guidelines recommend local tumour ablation (LTA) over partial nephrectomy (PN) in nonsurgical candidates; however, objective definitions of these candidates are lacking. OBJECTIVE: To identify specific patients who would benefit from LTA more than PN. DESIGN, SETTING, AND PARTICIPANTS: A population-based assessment was performed of 2476 patients in the Surveillance Epidemiology and End Results-Medicare database who had cT1a kidney cancer treated with either LTA or PN, between 2000 and 2009. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The outcome of the study was the relevant perioperative complications rate. A multivariable logistic regression model was fitted to predict the risk of complications after PN. Model-derived coefficients were used to calculate the risk of complication in case of PN among patients treated with LTA. Locally weighted scatterplot smoothing method was used to plot the observed complication rate against the predicted risk of complication in case of PN. RESULTS AND LIMITATIONS: At multivariable logistic regression, age (odds ratio [OR]: 1.04; p<0.001), Charlson comorbidity index (OR: 1.14; p<0.001), acute kidney injury (OR: 1.91; p=0.04), or chronic kidney disease (OR: 2.16; p=0.002), tumour size (OR: 1.02; p=0.01), and minimally invasive approach (OR: 0.77; p<0.03) emerged as significant predictors of complications. When LTA was chosen over PN, the reduction in the risk of complications was greatest in high-risk patients, intermediate in intermediate-risk patients, and least in low-risk patients. CONCLUSIONS: When postoperative complications are evaluated, the benefit of choosing LTA is not the same in all patients diagnosed with T1a kidney cancer. Specifically, patients at high risk of complications in case of PN may benefit the most from LTA and represent ideal LTA candidates. PATIENT SUMMARY: Elderly patients at high risk of complications in case of surgical treatment with partial nephrectomy for kidney cancer should be instructed that local tumour ablation might decrease their perioperative morbidity.
Authors: H Gilbert Welch; Jonathan S Skinner; Florian R Schroeck; Weiping Zhou; William C Black Journal: JAMA Intern Med Date: 2018-02-01 Impact factor: 21.873
Authors: Matthew J Maurice; Daniel Ramirez; Önder Kara; Ryan J Nelson; Peter A Caputo; Ercan Malkoç; Jihad H Kaouk Journal: Int Urol Nephrol Date: 2016-09-26 Impact factor: 2.370