Thermal Ablation Modalities That Best Compete with Partial Nephrectomy for T1A and T1B Renal Cell Carcinoma: A Network Meta-Analysis

Abstract

Purpose

To address the lack of consensus on the ranking of thermal ablation (TA) for treating T1A and T1B renal cell carcinoma (RCC), a network meta-analysis was conducted to compare the efficacy and safety of different TA modalities for managing early-stage RCC.

Methods

The Cochrane Library, PubMed, Scopus, and Web of Science were systematically searched for studies comparing percutaneous and laparoscopic radiofrequency ablation (RFA), cryoablation (CRA), and microwave ablation (MWA) with open, laparoscopic, and robotic partial nephrectomy (PN) for T1A and T1B RCC. Primary outcomes were recurrence-free survival (RFS), local recurrence, and postprocedural adverse events. Secondary outcomes included overall survival, cancer-specific mortality, changes in estimated glomerular filtration rate, hospital stay length, major adverse events, operation time, and systemic recurrence.

Results

Thirty-two studies were included, comprising 8,568 patients in T1A studies and 1,019 in T1B studies. For T1A tumors, no significant differences in 5-year RFS were observed between open PN and percutaneous RFA (P = .655), percutaneous CRA (P = .369), laparoscopic RFA (P = 1.000), or laparoscopic CRA (P = .547). However, percutaneous MWA reduced local recurrence (P = .033) and had lower postprocedural adverse events compared with PN (P = .029). For T1B tumors, no significant differences in 5-year RFS, local recurrence, or postprocedural adverse events were observed between open PN and percutaneous RFA or percutaneous CRA.

Conclusion

Although data gaps exist, percutaneous TA demonstrated outcomes comparable with surgery for both T1A and T1B renal tumors. For T1A tumors, percutaneous MWA may be highly effective. For T1B tumors, the similar outcomes across percutaneous approaches support tailoring treatment based on patient factors and operator expertise.