Introduction:
Thermal ablation has been touted as a “nephron-sparing” technique for localized renal cell cancer (RCC). However, there is an absence of data on the long-term effects of thermal ablation on renal function, particularly in patients with impaired baseline renal function. The objective of this project was to evaluate renal function outcomes in patients with biopsy proved RCC treated with thermal ablation.
Methods:
A total of 434 consecutive patients underwent thermal ablation (cryoablation or microwave ablation) for localized renal cell cancer from 2012 to 2020. All patients had biopsy proven renal cell carcinoma. Baseline patient and cancer characteristics were collected for all patients. Renal function data was collected at approximately 6- and 12- months following thermal ablation. Dialysis status and use of nephrotoxic medications was collected.
Results:
434 patients underwent 520 thermal ablations (range 1-12). Median follow-up was 30 months (IQR 9-61). A majority of ablations were for T1a tumors (431/516 82.9%). Among all patients, median baseline eGFR was 66 (IQR 49-84). At 6-months, the median eGFR dropped slightly among all patients to 62 (IQR 44-80) and remained stable at 12-months (median 61, IQR 45-79). Only 2 patients required initiation of dialysis following ablation.
Of the 520 ablations, 196 ablations (37.7%) had baseline eGFR worse than 60 (CKD Stage 3 or worse). Among these patients, average baseline eGFR was 42.6, which remained stable at 6-months (41.2) and 12-months (42.2) (Graph). On mixed effect analysis, there was no difference in eGFR at 6- and 12-months post-ablation (p=0.73). This was also confirmed with repeated measures ANOVA analysis (p=0.77). On multivariable analysis, tumor dimension was significantly associated with a drop in eGFR (beta -2.65, 95%CI -5.13, -0.17, p=0.04).
Conclusion:
Among allcomers, thermal ablation of renal cell cancer does result in a small drop in renal function at 6-months, however, after this renal function remains stable. However, in patients with baseline CKD Stage 3 or worse, thermal ablation provides a safe option for management of localized renal cell cancer in regard to preserving renal function.
Funding: N/A
Image(s) (click to enlarge):
THERMAL ABLATION FOR RENAL CELL CARCINOMA HAS MINIMAL EFFECTS ON RENAL FUNCTION IN PATIENTS WITH BASELINE IMPARIED RENAL FUNCTION
Category
Kidney Cancer > Localized
Description
Poster #23
Wednesday, Dec 1
2:00 p.m. - 3:00 p.m.
Kidney 1
Presented By: Arighno Das
Authors:
Arighno Das
Arighno Das
Gregory Raster
Tudor Borza
Fred Lee
Timothy Ziemlewicz
Shane Wells
E Jason Abel