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

Abstract

Purpose: Cryoablation (CA) and partial nephrectomy (PN) are effective nephron-sparing treatments for 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.

Materials and methods: 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 (CCI), tumor size, and nephrometry score. Disease-free survival (DFS), metastasis-free survival (MFS), cancer-specific survival (CSS), and overall survival (OS) were estimated using Kaplan-Meier analysis.

Results: One hundred thirteen and 57 patients underwent PN and CA with median follow-up of 4.5 and 3.8 years, respectively. CA was associated with significantly lower 5-year DFS compared to PN (75% vs. 94%, p<0.001). Local recurrence was more common after CA compared to PN (5.3% vs. 1.8%). Technical failure occurred with 32% of PCA. However, no significant differences were observed in 5-year MFS (100% for CA vs. 96% for PN, p=0.2) or CSS (100% for CA vs. 98% for PN, p=0.4).

Conclusions: CA is associated with lower DFS but similar MFS and CSS compared to 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.