Local recurrence and other oncologic outcomes after percutaneous image-guided tumor ablations on stageT1b renal cell carcinoma: a systematic review and network meta-analysis

Abstract

Objective: A systematic review of clinical trials on thermal ablation of T1b RCC was conducted to assess oncologic outcomes of those procedures. The primary endpoint was the rate of local recurrence. Secondary endpoints included technical efficacy, progression to metastatic disease, cancer-specific mortality, complications and renal function decrease. Methods: PubMed (MEDLINE) and Embase databases were searched in June 2020 for eligible trials following the PRISMA selection process. Prevalence of local recurrence and per procedural major adverse effects were calculated using double arcsine transformation and a random-effects model. Results: Nine clinical trials (all retrospective) involving 288 patients with T1b renal clear cell carcinoma treated with either percutaneous microwave ablation, cryoablation or radiofrequency ablation were analyzed. Using a random-effects model, the overall prevalence of local recurrence following percutaneous ablation was 0.08 (0.04–0.14; p = 0.05). Primary technical efficacy was 226/263 (86%) patients and secondary technical efficacy was 247/263 (94%). Overall, 10/176 (6%) patients presented metastatic locations following the ablation. Major adverse effects prevalence was 0.09 (0.06–0.14; p = 0.05). Conclusions: Thermal ablations are feasible, safe, and effective to treat T1b renal clear cell carcinoma. More trials are necessary to determine the rate of the evidence of the benefit.Highlights Thermal ablations are feasible and safe to treat T1b renal clear cell carcinoma. Oncologic outcomes appear to be very good on both local control and distant progression. Due to small number and heterogeneity of studies more trials are necessary to determine the rate of the evidence of the benefit.