Elsevier

Urology

Volume 78, Issue 1, July 2011, Pages 93-98
Urology

Oncology
Thermal Ablation vs Surgery for Localized Kidney Cancer: a Surveillance, Epidemiology, and End Results (SEER) Database Analysis

https://doi.org/10.1016/j.urology.2011.01.068Get rights and content

Objective

To evaluate contemporary national practice pattern trends in the use of thermal ablation (radiofrequency ablation and cryoablation) in the management of stage I renal cell carcinoma (RCC), and the factors that lead to using thermal ablation (TA) vs partial (PN) or radical nephrectomy (RN) in the United States.

Methods

Within the Surveillance, Epidemiology and End Results (SEER) database, we identified subjects with T1-N0M0 RCC treated with either PN, RN, or TA between 2004 and 2007. Proportions, trends, and multivariable logistic regression models tested the predictors of the use of TA.

Results

In total, 15,145 patients underwent a procedure for an RCC that was organ-confined and ≤7 cm. Of these, 578 underwent TA, 4402 underwent PN, and 10,165 underwent RN. On unadjusted analyses, patients who received TA were more likely to be older, single, have smaller tumor size, be diagnosed in more recent years, and have more unspecified histologic subtype and tumor grade. In multivariable adjusted analyses, single status (P = .02), male gender (P = .01), increasing age (P <.01), year of diagnosis (P <.01), and smaller tumor size (P <.01) were strong independent predictors of TA use compared with surgery (PN or RN). Further adjusted analyses showed no statistical difference in cancer-specific or overall survival between TA vs PN or RN.

Conclusions

TA use for stage I RCC increased over a relatively short period and was performed more commonly in patients of older age and with smaller tumor size. Longer follow-up is needed to assess the comparative effectiveness of TA vs surgery.

Section snippets

Data

Our patient sample was obtained from the most recent Surveillance, Epidemiology and End Results (SEER) data comprised of 17 regional tumor registries established by the National Cancer Institute, which was released in May 2010. SEER is an authoritative source of information on population-based cancer characteristics and represents approximately one quarter of the US population.16 The SEER registry collects information on cancer incidence and survival in the United States as well as information

Baseline Characteristics

Of 15,145 patients who underwent a procedure for a renal tumor that was ≤7 cm between 2004 and 2007, 578 underwent TA (RFA or CA), 4402 underwent PN, and 10,165 underwent RN. Table 1 illustrates the characteristics of the 578 patients who underwent TA, as compared to patients who underwent PN or RN during the same time period. On unadjusted analyses, there were statistically significant differences in term of age, year of diagnosis, marital status, tumor size (using the 4-cm cutoff or as a

Comment

To our knowledge, our study is the first population-based study to evaluate usage trends and practice patterns for ablative therapies for RCC in the United States. Our paper has several important findings worth discussing:

First, although the use of TA and PN are both increasing, only one third of patients with stage I RCC actually underwent either TA or PN (nephron-sparing procedures). Despite the reported oncologic equivalence and benefits of nephron-sparing procedures, two thirds of patients

Acknowledgments

This study used the linked SEER-Medicare database. The interpretation and reporting of these data are the sole responsibility of the authors. The authors acknowledge the efforts of the Applied Research Program, NCI; the Office of Research, Development and Information, CMS; Information Management Services (IMS), Inc.; and the Surveillance, Epidemiology and End Results (SEER) Program tumor registries in the creation of the SEER-Medicare database.

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Funding Support: This work was supported by the Trust Family Research Fund for Kidney Cancer presented to Toni K. Choueiri.

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