MedicalResearch.com Interview with:
Adam Talenfeld, M.D
Assistant Professor of Radiology
Weill Cornell Medical College
Assistant Attending Radiologist
New York-Presbyterian Hospital.
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: We know that renal function decreases as we age, and we know that decreased renal function is independently associated with increased mortality. This is why medical society guidelines recommend partial nephrectomy, which preserves kidney tissue and function, over radical nephrectomy for the treatment of the smallest kidney cancers, stage T1a tumors, which are under 4 cm diameter. Paradoxically, though, we know older patients are more likely than younger patients to receive radical nephrectomy for these smallest tumors, probably because it’s a simpler surgery than partial nephrectomy.
Percutaneous ablation, focal tissue destruction using heat or cold emanating from the tip of a needle, is a newer, image-guided, minimally-invasive, tissue-sparing treatment for solid organ tumors. We wanted to test how well percutaneous ablation would compare to partial nephrectomy and radical nephrectomy for these smallest kidney cancers.
We found that percutaneous ablation was associated with similar 5-year overall and cancer-specific survival compared to radical nephrectomy. At the same time, ablation was associated with significantly lower rates of new-onset chronic renal insufficiency and one-fifth as many serious non-urological complications than radical nephrectomy within 30 days of treatment. These were complications, such as deep venous thrombosis or pneumonia, that resulted in emergency department visits or new hospital admissions. The outcomes of percutaneous ablation compared with partial nephrectomy were somewhat less clear, though ablation was again associated with fewer perioperative complications.
MedicalResearch.com: What should readers take away from your report?
Response: For well-selected older patients requiring surgery for small renal cancers, percutaneous ablation may be equally as effective as and safer than radical nephrectomy.
For patients over age 65 and those with baseline renal insufficiency or other serious comorbid disease, patients and managing physicians should strongly consider percutaneous ablation, another nephron-sparing, curative treatment option, ahead of radical nephrectomy.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: One of the limitations of working with the National Cancer Institute’s Survival, Epidemiology and End-Results (SEER)-Medicare linked data is the time it takes to collect, validate and then link these many variables from many, many patients on an individual basis. So the data, and therefore our findings, so if the relative risks and benefits between has recently changed between treatment options, our data may not reflect these changes. We hope to do further comparative studies of these procedures, using more recent patient data and including some form of cost comparison.
MedicalResearch.com: Is there anything else you would like to add?
Response: Despite our efforts, our analysis may still be impacted by residual confounding arising from our use of real world data. This could happen both from factors for which we attempted to account, like younger age and better health in those selected for partial nephrectomy, as well as from characteristics for which we could not account, like the tumor’s location within the kidney, since this variable is not available in the SEER-Medicare data set. It’s important to remember that this treatment selection bias most often reflects appropriate clinical management, and the findings from our observational study apply to appropriately selected patients
Disclosures: This work was supported by unrestricted grants from the Association of University Radiologists and the Society of Interventional Radiology Foundation. The authors have no conflicts of interest relevant to this research.
Talenfeld AD, Gennarelli RL, Elkin EB, Atoria CL, Durack JC, Huang WC, et al. Percutaneous Ablation Versus Partial and Radical Nephrectomy for T1a Renal Cancer: A Population-Based Analysis. Ann Intern Med. [Epub ahead of print 26 June 2018] doi: 10.7326/M17-0585
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