Objectives: To test TRIFECTA achievement [1) absence of CLAVIEN-DINDO >= 3 complications; 2) complete ablation; 3) absence of >= 30% decrease in eGFR] and local recurrence rates, according to tumor size, in patients treated with thermal ablation (TA: radiofrequency [RFA] and microwave ablation [MWA]) for small renal masses. Methods: Retrospective analysis (2008-2020) of 432 patients treated with TA (RFA: 162 vs. MWA: 270). Tumor size was evaluated as: 1) continuously coded variable (cm); 2) tumor size strata (0.1-2 vs. 2.1-3 vs. 3.1-4 vs. > 4 cm). Multivariable logistic regression models and a min-imum P-value approach were used for testing TRIFECTA achievement. Kaplan-Meier plots depicted local recurrence rates over time. Results: Overall, 162 (37.5%) vs. 140 (32.4%) vs. 82 (19.0%) vs. 48 (11.1%) patients harboured, respectively, 0.1 to 2 vs. 2.1 to 3 vs. 3.1 to 4 vs. > 4 cm tumors. In multivariable logistic regression models, increasing tumor size was associated with higher rates of no TRIFECTA achievement (OR:1.11; P < 0.001). Using a minimum P-value approach, an optimal tumor size cut-off of 3.2 cm was identified (P < 0.001). In multivariable logistic regression models, 3.1 to 4 cm tumors (OR:1.27; P < 0.001) and > 4 cm tumors (OR:1.49; P < 0.001), but not 2.1 to 3 cm tumors (OR:1.05; P= 0.3) were associated with higher rates of no TRIFECTA achievement, relative to 0.1 to 2 cm tumors. The same results were observed in separate analyses of RFA vs. MWA patients. After a median (IQR) follow-up time of 22 (12-44) months, 8 (4.9%), 8 (5.7%), 11(13.4%), and 5 (10.4%) local recurrences were observed in tumors sized 0.1 to 2 vs. 2.1 to 3 vs. 3.1 to 4 vs. > 4 cm, respectively (P= 0.01). Conclusion: A tumor size cut-off value of <= 3 cm is associated with higher rates of TRIFECTA achievement and lower rates of local recurrence over time in patients treated with TA for small renal masses. (c) 2022 Elsevier Inc. All rights reserved.
Thermal ablation for small renal masses: Identifying the most appropriate tumor size cut-off for predicting perioperative and oncological outcomes
Di Trapani, Ettore;
2022-01-01
Abstract
Objectives: To test TRIFECTA achievement [1) absence of CLAVIEN-DINDO >= 3 complications; 2) complete ablation; 3) absence of >= 30% decrease in eGFR] and local recurrence rates, according to tumor size, in patients treated with thermal ablation (TA: radiofrequency [RFA] and microwave ablation [MWA]) for small renal masses. Methods: Retrospective analysis (2008-2020) of 432 patients treated with TA (RFA: 162 vs. MWA: 270). Tumor size was evaluated as: 1) continuously coded variable (cm); 2) tumor size strata (0.1-2 vs. 2.1-3 vs. 3.1-4 vs. > 4 cm). Multivariable logistic regression models and a min-imum P-value approach were used for testing TRIFECTA achievement. Kaplan-Meier plots depicted local recurrence rates over time. Results: Overall, 162 (37.5%) vs. 140 (32.4%) vs. 82 (19.0%) vs. 48 (11.1%) patients harboured, respectively, 0.1 to 2 vs. 2.1 to 3 vs. 3.1 to 4 vs. > 4 cm tumors. In multivariable logistic regression models, increasing tumor size was associated with higher rates of no TRIFECTA achievement (OR:1.11; P < 0.001). Using a minimum P-value approach, an optimal tumor size cut-off of 3.2 cm was identified (P < 0.001). In multivariable logistic regression models, 3.1 to 4 cm tumors (OR:1.27; P < 0.001) and > 4 cm tumors (OR:1.49; P < 0.001), but not 2.1 to 3 cm tumors (OR:1.05; P= 0.3) were associated with higher rates of no TRIFECTA achievement, relative to 0.1 to 2 cm tumors. The same results were observed in separate analyses of RFA vs. MWA patients. After a median (IQR) follow-up time of 22 (12-44) months, 8 (4.9%), 8 (5.7%), 11(13.4%), and 5 (10.4%) local recurrences were observed in tumors sized 0.1 to 2 vs. 2.1 to 3 vs. 3.1 to 4 vs. > 4 cm, respectively (P= 0.01). Conclusion: A tumor size cut-off value of <= 3 cm is associated with higher rates of TRIFECTA achievement and lower rates of local recurrence over time in patients treated with TA for small renal masses. (c) 2022 Elsevier Inc. All rights reserved.Pubblicazioni consigliate
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