Faculty Collaboration Database

Comprehensive assessment of renal tumour complexity in a large percutaneous cryoablation cohort. BJU Int 2017 Jun;119(6):905-912

Date

03/16/2017

Pubmed ID

28296030

DOI

10.1111/bju.13841

Scopus ID

2-s2.0-85017532953 (requires institutional sign-in at Scopus site)   17 Citations

Abstract

OBJECTIVE: To evaluate the association between renal tumour complexity and outcomes in a large cohort of patients undergoing percutaneous cryoablation (PCA).

PATIENTS AND METHODS: Patients with renal tumours treated with PCA were identified using our prospectively maintained ablation registry (2003-2015). Salvage procedures and inherited tumour syndromes were excluded. The associations between R.E.N.A.L. nephrometry score (NS) and risk of complications, renal function impairment, local failure and cancer-specific mortality (CSM) were evaluated using univariate and multivariable logistic, linear and Cox regression models.

RESULTS: The cohort included 618 tumours treated during 580 procedures in 565 patients. The median (interquartile range [IQR]) follow-up was 34 (14.66) months. Complications (any grade) during a procedure (n[total] = 87, 15%) were more frequent with higher NS (NS 4-6: 10%; NS 7-9: 14%; NS 10-12: 36%; P < 0.001). Higher NS was independently associated with risk of complications (odds ratio [OR; per 1 point] = 1.3; 95% confidence interval [CI] 1.2-1.5; P < 0.001). Of all the NS components, tumour size was the most strongly associated with complication risk (OR 3.4; 95% CI 2.2-5.2; P < 0.001). The median (IQR) decline in glomerular filtration rate (GFR) from baseline was 9% (0, 22) at last follow-up. Each additional point in NS was associated with a 1.3% (95% CI 0.4-2.1; P = 0.005) greater GFR decline from baseline. NS was not significantly associated with local failure (n [total] = 14, 2%; NS 4-6: 2%; NS 7-9: 3%; NS 10-12: 5%; P = 0.32) or CSM (n [total] = 8, 2%; NS 4-6: 2%; NS 7-9: 3%; NS 10-12: 2%; P = 0.88).

CONCLUSION: In high-complexity tumours PCA was associated with a tumour size-driven increased risk of post-procedural complications. Higher NS was associated with a small, clinically minor additional decline in renal function. Risks for local failure and CSM were low, regardless of tumour complexity.

Author List

Bhindi B, Thompson RH, Mason RJ, Haddad MM, Geske JR, Kurup AN, Hannon JD, Boorjian SA, Leibovich BC, Atwell TD, Schmit GD

Author

Mustafa Haddad MD Assistant Professor in the Radiology department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Aged
Cohort Studies
Cryosurgery
Female
Humans
Kidney Function Tests
Kidney Neoplasms
Male
Middle Aged
Postoperative Complications
Retrospective Studies
Treatment Outcome