TY - JOUR
T1 - Limitations of Available Studies Prevent Reliable Comparison Between Tumour Ablation and Partial Nephrectomy for Patients with Localised Renal Masses
T2 - A Systematic Review from the European Association of Urology Renal Cell Cancer Guideline Panel
AU - Abu-Ghanem, Yasmin
AU - Fernández-Pello, Sergio
AU - Bex, Axel
AU - Ljungberg, Börje
AU - Albiges, Laurence
AU - Dabestani, Saeed
AU - Giles, Rachel H.
AU - Hofmann, Fabian
AU - Hora, Milan
AU - Kuczyk, Markus A.
AU - Kuusk, Teele
AU - Marconi, Lorenzo
AU - Merseburger, Axel S.
AU - Tahbaz, Rana
AU - Staehler, Michael
AU - Volpe, Alessandro
AU - Powles, Thomas
AU - Lam, Thomas B.
AU - Bensalah, Karim
N1 - Publisher Copyright:
Copyright © 2020. Published by Elsevier B.V.
PY - 2020/8/1
Y1 - 2020/8/1
N2 - The European Association of Urology (EAU) Renal Cell Carcinoma (RCC) Guideline Panel performed a protocol-driven systematic review (SR) on thermal ablation (TA) compared with partial nephrectomy (PN) for T1N0M0 renal masses, in order to provide evidence to support its recommendations. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed, and only comparative studies published between 2000 and 2019 were included. Twenty-six nonrandomised comparative studies were included, recruiting a total of 167 80 patients. Risk of bias (RoB) assessment revealed high or uncertain RoB across all studies, with the vast majority being retrospective, observational studies with poorly matched controls and short follow-up. Limited data showed TA to be safe, but its long-term oncological effectiveness compared with PN remains uncertain. A quality assessment of pre-existing SRs (n=11) on the topic, using AMSTAR, revealed that all SRs had low confidence rating, with all but two SRs being rated critically low. In conclusion, the current data are inadequate to make any strong and clear conclusions regarding the clinical effectiveness of TA for treating T1N0M0 renal masses compared with PN. Therefore, TA may be cautiously considered an alternative to PN for T1N0M0 renal masses, but patients must be counselled carefully regarding the prevailing uncertainties. We recommend specific steps to improve the evidence base based on robust primary and secondary studies. PATIENT SUMMARY: In this report, we looked at the literature to determine the effectiveness of thermoablation (TA) in the treatment of small kidney tumours compared with surgical removal. We found that TA could cautiously be offered as an option due to many remaining uncertainties regarding its effectiveness.
AB - The European Association of Urology (EAU) Renal Cell Carcinoma (RCC) Guideline Panel performed a protocol-driven systematic review (SR) on thermal ablation (TA) compared with partial nephrectomy (PN) for T1N0M0 renal masses, in order to provide evidence to support its recommendations. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed, and only comparative studies published between 2000 and 2019 were included. Twenty-six nonrandomised comparative studies were included, recruiting a total of 167 80 patients. Risk of bias (RoB) assessment revealed high or uncertain RoB across all studies, with the vast majority being retrospective, observational studies with poorly matched controls and short follow-up. Limited data showed TA to be safe, but its long-term oncological effectiveness compared with PN remains uncertain. A quality assessment of pre-existing SRs (n=11) on the topic, using AMSTAR, revealed that all SRs had low confidence rating, with all but two SRs being rated critically low. In conclusion, the current data are inadequate to make any strong and clear conclusions regarding the clinical effectiveness of TA for treating T1N0M0 renal masses compared with PN. Therefore, TA may be cautiously considered an alternative to PN for T1N0M0 renal masses, but patients must be counselled carefully regarding the prevailing uncertainties. We recommend specific steps to improve the evidence base based on robust primary and secondary studies. PATIENT SUMMARY: In this report, we looked at the literature to determine the effectiveness of thermoablation (TA) in the treatment of small kidney tumours compared with surgical removal. We found that TA could cautiously be offered as an option due to many remaining uncertainties regarding its effectiveness.
KW - Ablative therapy
KW - European Association of Urology guidelines
KW - Partial nephrectomy
KW - Prognosis
KW - Renal cell cancer
UR - http://www.scopus.com/inward/record.url?scp=85089922635&partnerID=8YFLogxK
U2 - 10.1016/j.euo.2020.02.001
DO - 10.1016/j.euo.2020.02.001
M3 - Article
C2 - 32245655
AN - SCOPUS:85089922635
SN - 2588-9311
VL - 3
SP - 433
EP - 452
JO - European urology oncology
JF - European urology oncology
IS - 4
ER -