Intermediate-Term Oncologic Outcomes of Partial Nephrectomy vs Cryoablation in Renal Tumors > 3 cm: A Propensity Score-Matched Analysis.

Abstract

Cryoablation (CA) and partial nephrectomy (PN) are effective nephron-sparing treatments of small renal masses. While guidelines list thermal ablation as an option for tumors < 3 cm, limited data compare PN and CA in larger tumors. We compared intermediate-term oncologic outcomes between PN and CA in renal masses > 3 cm. Patients treated with PN or CA for cT1/cT2, N0M0 renal masses > 3 cm between 2006 and 2016 were identified. Propensity score matching was performed in a 1:2 ratio for patients undergoing CA or PN based on age, BMI, Charlson Comorbidity Index, tumor size, and nephrometry score. Disease-free survival (DFS), metastasis-free survival (MFS), cancer-specific survival (CSS), and overall survival were estimated using Kaplan-Meier analysis. One hundred thirteen and 57 patients underwent PN and CA with a median follow-up of 4.5 and 3.8 years, respectively. CA was associated with significantly lower 5-year DFS compared with PN (75% vs 94%, <i>P</i> < .001). Local recurrence was more common after CA compared with PN (5.3% vs 1.8%). Technical failure occurred with 32% of CA. However, no significant differences were observed in 5-year MFS (100% for CA vs 96% for PN, <i>P</i> = .2) or CSS (100% for CA vs 98% for PN, <i>P</i> = .4). CA is associated with lower DFS but similar MFS and CSS compared with PN in renal masses > 3 cm. CA is a viable option for well-selected patients with comorbidities or high surgical risk, when combined with salvage ablation as indicated.