Introduction & Objectives: To analyze our 10-year experience with Cryoablation (CA) ofSmall Renal Masses (SRM), and present the Trifecta Outcomes in these cohort of patients, by studying three topics: recurrence free survival (RFS) rate, functional kidney preservation, and complications free-recovery. Secondary outcome was evaluated the predictor factors of RFS. Materials & Methods: We retrospectively analyzed 181 patients who underwent 191 percutaneous or laparoscopic CAfor SRMs from 2007 and 2018 in 2 institutions. Data were collected and populations were divided into 2 equally groups in relation to the diameter (group 1: ≤20 mm - 82 CA; group 2: >20 mm - 109 CA). We defined RFS as the absence of imaging evidence of local disease recurrence during follow-up. Renal function preservation was defined as a percentage ratio of postoperative eGFR to preoperative eGFR. Complications were graded using the Clavien system. Cumulative incidence curves were generated for both groups and differences were analyzed using an appropriate test for competing risks (i.e. taking into account death without recurrence as a competing risk). The Cox proportional cause-specific model was used to determine factors associated with RFS. Trifecta was defined as cases with: no complications, no recurrence and <10% of ratio in eGFR pre- and post- treatment. Results: 168 (88%) cases of PCA and 23 (12%) of LCA were performed. Mean age was 70.93±9.83 (SD). Mean tumour size was 23.70±9,06. 179 masses were cT1a with a mean diameter of 22.17 mm ±7.02 (SD), while 12 masses were cT1b, with a mean diameter of 46.58 mm ±3.44 (SD). The rate of overall complications is 12.04%, 73.91% in group 2. Clavien >3 is 1.57% (2 IIIa and 1 IIIb). PADUA score (p=0.049) and number of cryoprobes (p<0.001) represents major risk factors. No variations in eGFR at 36 months: 6.04 [-7.65 – 17.23] for group 1 and 6.13 [-2.94 – 17.20] for group 2 (p=0.989). 24 (12,56%) recurrences were diagnosed on follow-up (21 local, 1 lymph-node, 2 needle-tract seeding). 2 biopsies of suspected lesion were performed. Median time to recurrence for the entire cohort of patients was 16 months [8-38 months]. Cumulative incidence of recurrence for group 1and group 2 at 36 months was 6% and 12% respectively. Younger Age (hazard ratio, 0.95; 95% confidence interval, 0.91-0.98; p=0.006) and mass >20 mm (hazard ratio, 3.40; 95% confidence interval, 1.18-9.86; p=0.024) were predictors of recurrence. Trifecta positive treatments at 24 months: 66.67% vs 62.90% (p=0.701). Conclusions: More than half of our patients did achieve the trifecta outcome, making CA a reliable treatment for patients not suitable for surgery. Masses ≤20 mm could be treated with a low risk of complication and recurrence, for masses >20 mm we recommend to discuss each patient in a multidisciplinary meeting.

Is cryoablation an effective treatment for trifecta outcomes in small renal masses? Long-term results from a multicenter cryotherapy registry

Barbati, G.;Gregorio, C.;Celia, A.;Bertolotto, M.;Stacul, F.;Cova, M. A.;Boltri, M.;Liguori, G.;Trombetta, C.;Pavan, N.
2019

Abstract

Introduction & Objectives: To analyze our 10-year experience with Cryoablation (CA) ofSmall Renal Masses (SRM), and present the Trifecta Outcomes in these cohort of patients, by studying three topics: recurrence free survival (RFS) rate, functional kidney preservation, and complications free-recovery. Secondary outcome was evaluated the predictor factors of RFS. Materials & Methods: We retrospectively analyzed 181 patients who underwent 191 percutaneous or laparoscopic CAfor SRMs from 2007 and 2018 in 2 institutions. Data were collected and populations were divided into 2 equally groups in relation to the diameter (group 1: ≤20 mm - 82 CA; group 2: >20 mm - 109 CA). We defined RFS as the absence of imaging evidence of local disease recurrence during follow-up. Renal function preservation was defined as a percentage ratio of postoperative eGFR to preoperative eGFR. Complications were graded using the Clavien system. Cumulative incidence curves were generated for both groups and differences were analyzed using an appropriate test for competing risks (i.e. taking into account death without recurrence as a competing risk). The Cox proportional cause-specific model was used to determine factors associated with RFS. Trifecta was defined as cases with: no complications, no recurrence and <10% of ratio in eGFR pre- and post- treatment. Results: 168 (88%) cases of PCA and 23 (12%) of LCA were performed. Mean age was 70.93±9.83 (SD). Mean tumour size was 23.70±9,06. 179 masses were cT1a with a mean diameter of 22.17 mm ±7.02 (SD), while 12 masses were cT1b, with a mean diameter of 46.58 mm ±3.44 (SD). The rate of overall complications is 12.04%, 73.91% in group 2. Clavien >3 is 1.57% (2 IIIa and 1 IIIb). PADUA score (p=0.049) and number of cryoprobes (p<0.001) represents major risk factors. No variations in eGFR at 36 months: 6.04 [-7.65 – 17.23] for group 1 and 6.13 [-2.94 – 17.20] for group 2 (p=0.989). 24 (12,56%) recurrences were diagnosed on follow-up (21 local, 1 lymph-node, 2 needle-tract seeding). 2 biopsies of suspected lesion were performed. Median time to recurrence for the entire cohort of patients was 16 months [8-38 months]. Cumulative incidence of recurrence for group 1and group 2 at 36 months was 6% and 12% respectively. Younger Age (hazard ratio, 0.95; 95% confidence interval, 0.91-0.98; p=0.006) and mass >20 mm (hazard ratio, 3.40; 95% confidence interval, 1.18-9.86; p=0.024) were predictors of recurrence. Trifecta positive treatments at 24 months: 66.67% vs 62.90% (p=0.701). Conclusions: More than half of our patients did achieve the trifecta outcome, making CA a reliable treatment for patients not suitable for surgery. Masses ≤20 mm could be treated with a low risk of complication and recurrence, for masses >20 mm we recommend to discuss each patient in a multidisciplinary meeting.
https://www.sciencedirect.com/science/article/abs/pii/S1569905619308917?via=ihub
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/11368/2959407
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