Five-year results from the prospective, multinational EuRECA registry support computed tomography (CT)-guided cryoablation for biopsy-proven T1a renal cell carcinoma (RCC), providing “benchmark” outcomes to support the technique as a nephron-sparing option for appropriately selected patients.
Presented at the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) annual congress (5–9 September, Copenhagen, Denmark), Ole Graumann (Aarhus University Hospital, Aarhus, Denmark) shared that the research team’s objective was to establish the long-term oncological outcomes and safety profile of cryoablation in patients with T1a RCC. Enrolling from December 2014 until December 2020, the 12 included centres span five countries across Europe.
The registry’s defined primary endpoint was local recurrence-free survival after primary technique efficacy, while secondary endpoints included residual unablated tumour, metastasis-free survival, cancer-specific survival, overall survival and 30-day complication rate.
Graumann detailed that exclusion criteria for the trial included patients with multiple renal tumours, prior RCC, hereditary renal cancer syndromes, tumours >4cm, non-CT-guided procedures, or no post-ablation imaging. Subsequently, 757 patients were evaluable, with a median age of 67.9 years; 66.2% of patients were male, median tumour size was 2.7cm and median RENAL nephrectomy score was 7. Median follow-up was defined as five years.
At five years, local recurrence-free survival was 96.1%, primary efficacy was 97.9%, and 97.6% of patients achieved metastasis-free survival, Graumann reported. Cancer-specific survival was reached in 99.2% of patients, while 86.1% achieved five-year overall survival. Referencing the lower overall survival rate, Graumann underscored the high rate of comorbidities in this patient population.
“All of these numbers are interesting, but even more interesting when compared to the other data out there,” said Graumann. He addressed CIRSE audience members who have published on cryoablation in T1a RCC, stating that, by pooling their collective results, they can see consistencies throughout, plotting an evidence base that supports the technique for this indication.
Following his presentation, session moderator Thomas Helmberger (Städtischen Klinikum München, Munich, Germany) stated that the registry is a “milestone”, terming it “the COLLISION of the kidney”; however, he queried how urologists will be convinced to deviate from the long-established treatment pathway. To this, Graumann remained hopeful, stating that the present data should produce a change in guideline recommendations in the near future.
