Differential efficacy of ablation therapy versus partial nephrectomy between clinical T1a and T1b renal tumors: A systematic review and meta-analysis
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Differential efficacy of ablation therapy versus partial nephrectomy between clinical T1a and T1b renal tumors: A systematic review and meta-analysis. / Yanagisawa, Takafumi; Mori, Keiichiro; Kawada, Tatsushi; Motlagh, Reza Sari; Mostafaei, Hadi; Quhal, Fahad; Laukhtina, Ekaterina; Rajwa, Pawel; Aydh, Abdulmajeed; König, Frederik; Pallauf, Maximilian; Pradere, Benjamin; Miki, Jun; Kimura, Takahiro; Egawa, Shin; Shariat, Shahrokh F.
In: UROL ONCOL-SEMIN ORI, Vol. 40, No. 7, 07.2022, p. 315-330.Research output: SCORING: Contribution to journal › SCORING: Review article › Research
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TY - JOUR
T1 - Differential efficacy of ablation therapy versus partial nephrectomy between clinical T1a and T1b renal tumors: A systematic review and meta-analysis
AU - Yanagisawa, Takafumi
AU - Mori, Keiichiro
AU - Kawada, Tatsushi
AU - Motlagh, Reza Sari
AU - Mostafaei, Hadi
AU - Quhal, Fahad
AU - Laukhtina, Ekaterina
AU - Rajwa, Pawel
AU - Aydh, Abdulmajeed
AU - König, Frederik
AU - Pallauf, Maximilian
AU - Pradere, Benjamin
AU - Miki, Jun
AU - Kimura, Takahiro
AU - Egawa, Shin
AU - Shariat, Shahrokh F
N1 - Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.
PY - 2022/7
Y1 - 2022/7
N2 - PURPOSE: To assess the differential clinical outcomes of patients treated with partial nephrectomy (PN) vs. those treated with ablation therapy (AT) such as radiofrequency ablation, cryoablation and microwave ablation for cT1b compared to cT1a renal tumors.MATERIALS AND METHODS: Multiple databases were searched for articles published before August 2021. Studies were deemed eligible if they compared clinical outcomes in patients who underwent PN with those who underwent AT for cT1a and/or cT1b renal tumors.RESULTS: Overall, 27 studies comprising 13,996 patients were eligible for this meta-analysis. In both cT1a and cT1b renal tumors, there was no significant difference in the percent decline of estimated glomerular filtration rates or in the overall/severe complication rates between PN and AT. Compared to AT, PN was associated with a lower risk of local recurrence in both patients with cT1a and cT1b tumors (cT1a: pooled risk ratio [RR]; 0.43, 95% confidence intervals [CI]; 0.28-0.66, cT1b: pooled RR; 0.41, 95%CI; 0.23-0.75). Subgroup analyses regarding the technical approach revealed no statistical difference in local recurrence rates between percutaneous AT and PN in patients with cT1a tumors (pooled RR; 0.61, 95%CI; 0.32-1.15). In cT1b, however, PN was associated with a lower risk of local recurrence (pooled RR; 0.45, 95%CI; 0.23-0.88). There was no difference in distant metastasis or cancer mortality rates between PN and AT in patients with cT1a, or cT1b tumors.CONCLUSIONS: AT has a substantially relevant disadvantage with regards to local recurrence compared to PN, particularly in cT1b renal tumors. Despite the limitations inherent to the nature of retrospective and unmatched primary cohorts, percutaneous AT could be used as a reasonable alternative treatment for well-selected patients with cT1a renal tumors.
AB - PURPOSE: To assess the differential clinical outcomes of patients treated with partial nephrectomy (PN) vs. those treated with ablation therapy (AT) such as radiofrequency ablation, cryoablation and microwave ablation for cT1b compared to cT1a renal tumors.MATERIALS AND METHODS: Multiple databases were searched for articles published before August 2021. Studies were deemed eligible if they compared clinical outcomes in patients who underwent PN with those who underwent AT for cT1a and/or cT1b renal tumors.RESULTS: Overall, 27 studies comprising 13,996 patients were eligible for this meta-analysis. In both cT1a and cT1b renal tumors, there was no significant difference in the percent decline of estimated glomerular filtration rates or in the overall/severe complication rates between PN and AT. Compared to AT, PN was associated with a lower risk of local recurrence in both patients with cT1a and cT1b tumors (cT1a: pooled risk ratio [RR]; 0.43, 95% confidence intervals [CI]; 0.28-0.66, cT1b: pooled RR; 0.41, 95%CI; 0.23-0.75). Subgroup analyses regarding the technical approach revealed no statistical difference in local recurrence rates between percutaneous AT and PN in patients with cT1a tumors (pooled RR; 0.61, 95%CI; 0.32-1.15). In cT1b, however, PN was associated with a lower risk of local recurrence (pooled RR; 0.45, 95%CI; 0.23-0.88). There was no difference in distant metastasis or cancer mortality rates between PN and AT in patients with cT1a, or cT1b tumors.CONCLUSIONS: AT has a substantially relevant disadvantage with regards to local recurrence compared to PN, particularly in cT1b renal tumors. Despite the limitations inherent to the nature of retrospective and unmatched primary cohorts, percutaneous AT could be used as a reasonable alternative treatment for well-selected patients with cT1a renal tumors.
KW - Carcinoma, Renal Cell/pathology
KW - Humans
KW - Kidney Neoplasms/pathology
KW - Neoplasm Staging
KW - Nephrectomy/adverse effects
KW - Retrospective Studies
KW - Treatment Outcome
U2 - 10.1016/j.urolonc.2022.04.002
DO - 10.1016/j.urolonc.2022.04.002
M3 - SCORING: Review article
C2 - 35562311
VL - 40
SP - 315
EP - 330
JO - UROL ONCOL-SEMIN ORI
JF - UROL ONCOL-SEMIN ORI
SN - 1078-1439
IS - 7
ER -
