Abstract
To determine the long-term survival of patients treated with percutaneous radiofrequency ablation (RFA) for pathologically proven renal cell carcinoma (RCC). In this single-center retrospective study, a study cohort of 100 patients with 125 RCCs (100 clear cell, 19 papillary and 6 chromophobe) ranging in size from 0.8 cm to 8 cm treated with RFA were evaluated at a single large tertiary care center between 2004 and 2015. Technical success, primary and secondary technique efficacy, pre- and postprocedural estimated glomerular filtration rate (eGFR) at 3 – 6 months and 2 – 3 years were recorded. Overall survival, cancer-specific survival, and local tumor progression-free survival by Kaplan-Meier survival curves were calculated. Complications were classified using the Clavien-Dindo system. Statistical testing was done via Chi-squared tests for proportions and the paired-t test for change in eGFR. Statistical significance was set at α = 0.05. Overall technical success was 100% and primary and secondary technique efficacy were 90% and 100%, respectively. Median follow-up was 62.8 months, ranging from 1 – 120 months. The 10-year overall, cancer-specific, and local progression-free survival rates were 32%, 86%, and 92%, respectively. The number of ablation probes used was predictive of residual unablated tumor (P < 0.001). There were no significant changes in pre procedure vs. 2 to 3 years post procedure eGFR (65.2 vs. 62.1 mL/minute/1.73 m2, P = 0.443). The overall complication rate was 9%, the majority of which were grade I. Image-guided percutaneous RFA of RCCs is effective at achieving local control and preventing cancer-specific death within 10 years from initial treatment.Tabled 1Residual TumorComplicationsTumor ProgressionTumor TypeYesNoYesNoYesNoClear cell13 (13%)87 (87%)10 (10%)90 (90%)7 (7%)93 (93%)Papillary0 (0%)19 (100%)1 (6%)18 (94%)0 (0%)19 (100%)Chromophobe0 (0%)6 (100%)0 (0%)6 (100%)1 (17%)5 (83%)P0.1630.5900.299Tumor size≤4cm11 (10%)106 (90%)10 (9%)107 (91%)7 (6%)110 (94%)>4cm2 (25%)6 (75%)1 (13%)7 (87%)1 (13%)7 (87%)P0.1620.7020.466PolarityUpper pole3 (9%)31 (91%)3 (9%)31 (91%)1 (3%)33 (97%)Mid pole5 (11%)41 (89%)3 (7%)43 (93%)6 (13%)40 (87%)Lower pole5 (11%)40 (89%)5 (11%)40 (89%)1 (2%)44 (98%)P0.9390.8330.068MorphologyExophytic7 (16%)36 (84%)4 (9%)39 (91%)3 (7%)40 (93%)Endophytic6 (7%)76 (93%)7 (9%)75 (91%)5 (6%)77 (94%)P0.1190.8850.850LocationAnterior7 (18%)31 (82%)3 (8%)35 (92%)3 (8%)35 (92%)Lateral1 (3%)31 (97%)2 (6%)30 (94%)2 (6%)30 (94%)Posterior5 (9%)50 (91%)6 (11%)49 (89%)3 (5%)52 (95%)P0.1030.7400.894LateralityLeft9 (16%)46 (84%)8 (15%)47 (85%)5 (9%)50 (91%)Right4 (6%)66 (94%)3 (4%)67 (96%)3 (4%)67 (96%)P0.0530.0440.280Ablation Probes10 (0%)65 (100%)1 (2%)64 (98%)1 (2%)64 (98%)23 (8%)36 (92%)7 (18%)32 (82%)5 (13%)34 (87%)310 (45%)11 (55%)3 (14%)18 (86%)2 (10%)19 (90%)P<0.0010.0100.061 Open table in a new tab
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