Impact of Partial Nephrectomy and Percutaneous Cryoablation on Short-term Health-related Quality of Life-A Prospective Comparative Cohort Study

Theresa Junker; Louise Duus; Benjamin S B Rasmussen; Nessn Azawi; Lars Lund; Birgitte Nørgaard; Ole Graumann

doi:10.1016/j.euros.2022.09.013

Impact of Partial Nephrectomy and Percutaneous Cryoablation on Short-term Health-related Quality of Life-A Prospective Comparative Cohort Study

Eur Urol Open Sci. 2022 Oct 17:45:99-107. doi: 10.1016/j.euros.2022.09.013. eCollection 2022 Nov.

Authors

Theresa Junker^{1

2

3

4}, Louise Duus^{1

2

4}, Benjamin S B Rasmussen^{1

2

4}, Nessn Azawi^{5

6}, Lars Lund^{2

3

4}, Birgitte Nørgaard⁷, Ole Graumann^{1

2

4}

Affiliations

¹ Department of Radiology, Odense University Hospital, Odense, Denmark.
² Department of Clinical Research, University of Southern, Odense, Denmark.
³ Department of Urology, Odense University Hospital, Odense, Denmark.
⁴ Open Patient Data Explorative Network, Department of Clinical Research, University of Southern, Odense, Denmark.
⁵ Department of Urology, Zealand University Hospital, Roskilde, Denmark.
⁶ Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
⁷ Department of Public Health, University of Southern, Odense, Denmark.

Abstract

Background: Partial nephrectomy (PN) is the gold standard for the treatment of stage cT1 renal cell carcinoma (RCC). However, the increasing incidence of RCC in the elderly population calls for alternative minimally invasive treatments to reduce the negative effects on patients' health-related quality of life (HRQoL) and subsequent healthy life expectancy.

Objective: To assess and compare short-term HRQoL and self-reported health status after PN and percutaneous cryoablation (PCA) of patients treated for RCC stage cT1.

Design setting and participants: Patients who underwent PN or PCA between 2019 and 2021 for RCC stage cT1 at two university hospitals in Denmark were assessed. The exclusion criteria included insufficient understanding of the Danish language, dementia, metastatic RCC, conversion to nephrectomy, and salvage procedures.

Intervention: PN and PCA.

Outcome measurements and statistical analysis: The European Organisation for the Research and Treatment of Cancer Quality of Life Questionnaire was distributed before treatment, and 14 and 90 d postoperatively. A linear mixed-effect model was used to analyze the changes from baseline to follow-up between PN and PCA treatment.

Results and limitations: The cohort included 165 patients (PN: 79; PCA: 86). The completion rate was 96-98%. Patients receiving PCA were significantly older (median 69.1 vs 62.1 yr) and had lower scores on physical (p < 0.001) and role functioning (p = 0.009) than PN. A statistically significant change from baseline to 14 d was found for several HRQoL scales, which favored PCA over PN. However, the observed change was no longer significant at 90-d follow-up. Limitations include sample size and confounding by indication.

Conclusions: This study found a significant difference between baseline and 14-d follow-up in several HRQoL and symptoms scales, favoring PCA over PN. However, no significant differences were observed in any HRQoL scales between PN and PCA of RCC stage cT1 from baseline to 90-d follow-up.

Patient summary: Surgical removal and percutaneous cryoablation (freezing) of small tumors in the kidney had a similar impact on quality of life after 90 d.

Keywords: Cryoablation; Health-related quality of life; Nephron-sparing treatment; Partial nephrectomy; Patient-reported outcome; Quality of life; Renal cell carcinoma.