Nima Kokabi MD, Presenter: Nothing to Disclose

Minzhi Xing MD, Abstract Co-Author: Nothing to Disclose

Richard Duszak MD, Abstract Co-Author: Nothing to Disclose

Kimberly E. Applegate MD, MS, Abstract Co-Author: Co-editor, Springer Science+Business Media Deutschland GmbH Advisory Board, WellPoint, Inc

Juan Camilo Camacho, Abstract Co-Author: Nothing to Disclose

David H. Howard PhD, Abstract Co-Author: Nothing to Disclose

Hyun Sik Kim MD, Abstract Co-Author: Nothing to Disclose

To investigate contemporary national practice trends in the utilization of percutaneous thermal ablation (TA) (radio frequency ablation (RFA) and cryoablation (CRA)) for treating stage I renal cell carcinoma (RCC) and identify possible sociodemographic factors that determine receipt of surgical vs. TA therapy. 

Using the most update SEER database, we identified all patients with stage T1N0M0 RCC who were diagnosed between years 2004 to 2010 and underwent either TA or surgical resection (partial nephrectomy (PN) or radical nephrectomy (RN)). Sociodemographic, geographic, and clinical determinants of trends in use of surgery vs. TA were evaluated using chi-square and logistic regression models. Sub-analysis of differences in utilization of TA between 2004-2007 vs. 2008-2010 was also performed. 

Overall, 39,307 patients were diagnosed with T1N0M0 RCC. Of those, 37,739 (96%) underwent surgical resection (13,442 PN and 24,297 RN). Of the remaining 1568 patients who were treated with thermal ablation, 921 received CRA and 647 underwent RFA. There was no significant difference in the proportion of TA’s performed between 2004-2007 vs. 2008-2010 (3.8% vs. 4.1%, p=0.43). The proportion of cryoblation performed between 2008-2010 was significantly higher compared to the prior 3 years (23% vs. 65%, p<0.001). Patients with older age, smaller tumor size (<4cm), lower histologic grade of tumor (I & II), residing in urban settings, with higher education levels, and higher median income were more likely to receive TA according to both uni- and multivariate analyses. 

Only a small proportion of organ-confined stage 1 RCC appear to be treated by TA with potential underutilization of less invasive percutaneous therapies compared to surgery. Older age, smaller tumor size, and more favorable sociodemographics status are significant determinants of receipts of TA vs. surgery. 

There appears to be significant underutlization of less invasive percutaneous thermal ablation therapies for treatment of stage 1 RCC, which are also less costly with lower associated complication rates compared to surgery. 

Kokabi, N, Xing, M, Duszak, R, Applegate, K, Camacho, J, Howard, D, Kim, H, Contemporary Clinical Trends in Surgical Resection vs. Percutaneous Thermal Ablation Therapy for Stage I Renal Cell Carcinoma: A Surveillance, Epidemiology and End Results (SEER) Population Study .  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14019699.html