Local ablation vs partial nephrectomy in T1N0M0 renal cell carcinoma: An inverse probability of treatment weighting analysis

Abstract

Objective: To compare the survival outcomes of local ablation (LA) and partial nephrectomy (PN) for T1N0M0 renal cell carcinoma (RCC). Method: We identified 38,155 T1N0M0 RCC patients treated with PN or LA in 2004-2016 from the retrospective Surveillance, Epidemiology, and End Results databases. Among them, there were 4656 LA and 33,499 PN. A Cox proportional hazards regression model, cause-specific Cox regression and Fine and Gray sub-distribution hazard ratio (sHR) with inverse probability of treatment weighting (IPTW) adjusting was utilized to compare the effects of LA vs PN on all-, RCC-, and non-RCC–caused mortality. Results: Within the IPTW analysis, patients who underwent PN experienced a better overall survival (OS) (HR, 1.56; 95% CI, 1.40-1.74; P 85 years (HR, 1.14; 95% CI, 0.73-1.79, P =.577), chromophobe RCC (HR, 1.68; 95% CI, 0.94-3.00, P =.078), and tumor size <2 cm (HR, 1.21; 95% CI, 0.95-1.53, P =.126), the OS showed no significant difference between LA and PN. No significant difference in CSS between LA and PN was observed in the subgroup of chromophobe RCC (HR, 0.34; 95% CI, 0.03-3.97, P =.389), and tumor size <2 cm (HR, 1.83; 95% CI, 0.92-3.64, P =.084). For patients >85 years (sHR, 0.89; 95% CI, 0.52-1.27, P =.520) and tumor size <2 cm (sHR, 1.14; 95% CI, 0.94-1.38, P =.200), the non-RCC–specific mortality was not significantly different in PN and LA cohorts, however, for the chromophobe RCC, the LA showed a worse non-RCC mortality than PN (HR, 1.72; 95% CI, 1.06-2.79, P =.028). Conclusion: PN showed a better prognosis than LA in T1N0M0 RCC treatment, but LA and PN showed a comparable OS in elderly patients (>85), small RCC (<2 cm) and chromophobe RCC.