Mp56-06 Novel Renal Cell Carcinoma TNM Staging Classification: Where Does Microwave Ablation Finds Its Indication?

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy IV (MP56)1 May 2024MP56-06 NOVEL RENAL CELL CARCINOMA TNM STAGING CLASSIFICATION: WHERE DOES MICROWAVE ABLATION FINDS ITS INDICATION? Andrea Piccolini, Pietro Diana, Alessandro Uleri, Filippo Dagnino, Edoardo Beatrici, Cesare Saitta, Giuseppe Garofano, Giovanni Lughezzani, Massimo Lazzeri, Paolo Casale, Alberto Saita, Rodolfo Hurle, Vittorio Pedicini, and Nicolò Buffi Andrea PiccoliniAndrea Piccolini , Pietro DianaPietro Diana , Alessandro UleriAlessandro Uleri , Filippo DagninoFilippo Dagnino , Edoardo BeatriciEdoardo Beatrici , Cesare SaittaCesare Saitta , Giuseppe GarofanoGiuseppe Garofano , Giovanni LughezzaniGiovanni Lughezzani , Massimo LazzeriMassimo Lazzeri , Paolo CasalePaolo Casale , Alberto SaitaAlberto Saita , Rodolfo HurleRodolfo Hurle , Vittorio PediciniVittorio Pedicini , and Nicolò BuffiNicolò Buffi View All Author Informationhttps://doi.org/10.1097/01.JU.0001008940.44711.d4.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Thermal ablation (TA) is gaining importance as an alternative treatment in frail comorbid patients. The European Association of Urology (EAU) Panel proposed a renewal of RCC-TNM staging setting 3 cm as cT1a/b cut-off. This complies with the current decision-making advances: active surveillance and TA for cT1a masses, secondary options in cT1b pts if surgery unfit. Despite microwave ablation (MWA) conveys more thermal energy to the tissue compared to radiofrequency ablation, allowing to overcome the heat-sink effect providing a larger ablation zone, no solid evidences are present in the treatment of new cT1b masses. Our study analyzes operative/oncological outcomes of MWA in patients diagnosed with renal masses according to the novel classification. METHODS: This study retrospectively analyzes a single center database of patients diagnosed with cT1 renal masses subjected to MWA (04/2018 - 09/2021). Primary outcomes: safety and feasibility (disease persistency) at 2 months post-TA at CT-scan. Chi-square test was used to compare renal function according to renal mass clinical stage. Logistic regression analysis was employed to investigate the relationship between stage and disease persistence. RESULTS: Out of 120 patients 23 were lost in follow-up because followed at another center. 97 pts were analyzed. Median (IQR) age was 70 (59-74), in 50 (51.5%) patients right kidney was affected. 71/26 (73/27%) were cT1a/cT1b. 25/30/16 (35/42/23%) in cT1a group and 4/9/13 (15/35/50%) in cT1b group were considered low/intermediate/high risk according to PADUA score (p=0.02). 10 (14%) and 10 (37%) pts required a double ablation during the same intervention (p=0.009), in cT1a/cT1b group. 1 and 5 (1.4 and 19%) pts reported a significant (Clavien-Dindo >2) post-TA complications cT1a/cT1b group (p=0.001). 3 patients/group died for other causes within the first 2 months post-TA. CT-scan performed at 2 months post-TA identified 9% (6/68) and 35% (8/23) disease persistency in cT1a/cT1b group (p=0.002). At logistic regression the risk of disease persistency for cT1b group at 2 months CT-scan was 4 folds higher (p<0.001) compared to cT1a masses. CONCLUSIONS: Advances of technologies and tools and active surveillance and TA is gaining more solid role in RCC indications. While TA in novel cT1a may potentially bear an acceptable safety profile, pts presenting with cT1b renal mass should undergo a careful selection and counselling before indicating TA as both complications and disease persistency at 2 months post-TA are statistically significantly higher compared to cT1a masses. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e927 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Andrea Piccolini More articles by this author Pietro Diana More articles by this author Alessandro Uleri More articles by this author Filippo Dagnino More articles by this author Edoardo Beatrici More articles by this author Cesare Saitta More articles by this author Giuseppe Garofano More articles by this author Giovanni Lughezzani More articles by this author Massimo Lazzeri More articles by this author Paolo Casale More articles by this author Alberto Saita More articles by this author Rodolfo Hurle More articles by this author Vittorio Pedicini More articles by this author Nicolò Buffi More articles by this author Expand All Advertisement PDF downloadLoading ...