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Limitations of Available Studies Prevent Reliable Comparison Between Tumour Ablation and Partial Nephrectomy for Patients with Localised Renal Masses : A Systematic Review from the European Association of Urology Renal Cell Cancer Guideline Panel

Abu-Ghanem, Yasmin ; Fernández-Pello, Sergio ; Bex, Axel ; Ljungberg, Börje ; Albiges, Laurence ; Dabestani, Saeed LU ; Giles, Rachel H. ; Hofmann, Fabian ; Hora, Milan and Kuczyk, Markus A. , et al. (2020) In European Urology Oncology 3(4). p.433-452
Abstract

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... (More)

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.

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publishing date
type
Contribution to journal
publication status
published
subject
keywords
Ablative therapy, European Association of Urology guidelines, Partial nephrectomy, Prognosis, Renal cell cancer
in
European Urology Oncology
volume
3
issue
4
pages
20 pages
publisher
Elsevier
external identifiers
  • scopus:85089922635
  • pmid:32245655
ISSN
2588-9311
DOI
10.1016/j.euo.2020.02.001
language
English
LU publication?
no
id
89ac315e-3bc9-42aa-8aac-7efb24647a20
date added to LUP
2020-09-08 14:02:30
date last changed
2022-05-24 01:02:03
@article{89ac315e-3bc9-42aa-8aac-7efb24647a20,
  abstract     = {{<p>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.</p>}},
  author       = {{Abu-Ghanem, Yasmin and Fernández-Pello, Sergio and Bex, Axel and Ljungberg, Börje and Albiges, Laurence and Dabestani, Saeed and Giles, Rachel H. and Hofmann, Fabian and Hora, Milan and Kuczyk, Markus A. and Kuusk, Teele and Marconi, Lorenzo and Merseburger, Axel S. and Tahbaz, Rana and Staehler, Michael and Volpe, Alessandro and Powles, Thomas and Lam, Thomas B. and Bensalah, Karim}},
  issn         = {{2588-9311}},
  keywords     = {{Ablative therapy; European Association of Urology guidelines; Partial nephrectomy; Prognosis; Renal cell cancer}},
  language     = {{eng}},
  number       = {{4}},
  pages        = {{433--452}},
  publisher    = {{Elsevier}},
  series       = {{European Urology Oncology}},
  title        = {{Limitations of Available Studies Prevent Reliable Comparison Between Tumour Ablation and Partial Nephrectomy for Patients with Localised Renal Masses : A Systematic Review from the European Association of Urology Renal Cell Cancer Guideline Panel}},
  url          = {{http://dx.doi.org/10.1016/j.euo.2020.02.001}},
  doi          = {{10.1016/j.euo.2020.02.001}},
  volume       = {{3}},
  year         = {{2020}},
}