Partial Nephrectomy vs Thermal Ablation for Non-Clear Cell RCC: The UNCLEAR Study (UroCCR 172)
Abstract Purpose To compare disease-free survival (DFS) between partial nephrectomy (PN) and percutaneous ablation (PCA) in patients with non-clear cell renal cell carcinoma (nccRCC), and to identify independent predictors of disease recurrence. Methods We performed a retrospective, propensity score-matched analysis of prospectively collected data from the UroCCR registry, including 31 centers (2009–2023). Patients with histologically confirmed cT1a nccRCC treated by PN or PCA were included. Propensity matching (2:1) was based on previous RCC history, tumor size, and histological subtype. DFS was defined as time to first recurrence documented on computed tomography. Results After propensity matching, 174 patients were included (PN n = 116; PCA n = 58). Median follow-up was 3.2 years, with 18 recurrences. Five-year DFS was significantly higher after PN than PCA (88.7% vs. 76.8%; HR = 3.11, 95%CI 1.21–8.01; p = 0.018). Previous RCC was the strongest independent predictor of worse DFS in multivariate analysis (HR = 6.23, 95%CI 2.49–15.58; p < 0.01). In univariate exploratory subgroup analyses, the DFS advantage of PN was most pronounced in pRCC (HR = 3.44, 95%CI 1.03–11.46; p = 0.044) and in patients without prior renal malignancy (HR = 6.49; p = 0.005), whereas no statistically significant difference was observed in chRCC. The difference was no longer significant in a post hoc sensitivity analysis restricted to R0 PN and excluding early local recurrences after PCA (HR = 1.85, 95%CI 0.55–6.23; p = 0.32). Conclusion In cT1a nccRCC, PN was associated with longer DFS than PCA after propensity matching, particularly in pRCC. Overall survival impact needs prospective evaluation.
Authors
- Matthieu Garnier (ORCID: https://orcid.org/0000-0001-7391-547X)
- M. Vallée (ORCID: https://orcid.org/0000-0001-9532-3723)
- Alexis Fontenil
- Khalil Chalhoub (ORCID: https://orcid.org/0000-0002-3529-1974)
- Gilles Piana (ORCID: https://orcid.org/0000-0003-2220-8294)
- Christian Sengel (ORCID: https://orcid.org/0000-0001-9004-256X)
- Afshin Gangi (ORCID: https://orcid.org/0000-0002-0952-7760)
- Édouard Reizine (ORCID: https://orcid.org/0000-0002-6055-8191)
- Louis Vignot (ORCID: https://orcid.org/0000-0002-6826-3590)
- Ana Mihaila
- J. Guillotreau
- François Audenet (ORCID: https://orcid.org/0000-0001-5722-2075)
- F. Bruyère (ORCID: https://orcid.org/0000-0002-9281-9421)
- Amandine Claudinot (ORCID: https://orcid.org/0009-0009-0972-1713)
- S. Larré (ORCID: https://orcid.org/0000-0003-2558-1035)
- Victoire Cartier
- O. Belas
- Raphaële Renard‐Penna (ORCID: https://orcid.org/0000-0001-8484-4590)
- Jean‐Christophe Bernhard (ORCID: https://orcid.org/0000-0001-8564-1699)
- Bastien Parier
- Pierre Bigot (ORCID: https://orcid.org/0000-0002-5669-9020)
- Arthur David (ORCID: https://orcid.org/0000-0002-6401-0035)
- N. Doumerc (ORCID: https://orcid.org/0000-0001-6133-4213)
- Karim Bensalah (ORCID: https://orcid.org/0000-0003-4559-2559)
- Cécile Maud Champy (ORCID: https://orcid.org/0000-0002-3103-4399)
- Morgan Rouprêt A (ORCID: https://orcid.org/0000-0001-8440-7075)
- Eva Jambon (ORCID: https://orcid.org/0000-0001-5002-472X)
- É. Bruguière
- R. Boissier (ORCID: https://orcid.org/0000-0001-6428-0273)
- Jonathan Olivier (ORCID: https://orcid.org/0000-0002-5409-2911)
- S. De Vergie (ORCID: https://orcid.org/0000-0002-6308-602X)
- Florian Maxwell
- Thibaut Waeckel (ORCID: https://orcid.org/0000-0002-5775-479X)
- Luc Beuzit
- Charles Raffaelli
- Clément Sarrazin (ORCID: https://orcid.org/0000-0002-3338-5678)
- Philippe Puech (ORCID: https://orcid.org/0000-0003-0383-5137)
- Maud Hulin (ORCID: https://orcid.org/0000-0002-3200-7309)
- Sarah Montagne (ORCID: https://orcid.org/0000-0003-2571-3077)
- Louis Surlemont (ORCID: https://orcid.org/0000-0002-1580-9684)
- Fayek Taha (ORCID: https://orcid.org/0000-0001-6082-0332)
- Jean‐Jacques Patard
- C. Nedelcu
- Hervé Lang
- Isabelle Boulay
- P. Paparel
- Frédéric Panthier
- Constance Michel
- Valentin Caillault
- Séverine Lagarde-Doumerc
- Mohamed Simpara
- Nicolas Branger
Institutions
- Aix-Marseille Université (FR)
- Centre Hospitalier Universitaire de Grenoble (FR)
- Centre Hospitalier Universitaire de Lille (FR)
- Centre Hospitalier Universitaire de Nice (FR)
- Centre Hospitalier Universitaire de Nantes (FR)
- Sorbonne Université (FR)
- Centre Hospitalier Universitaire de Tours (FR)
- Hôpital de la Conception (FR)
- Assistance Publique – Hôpitaux de Paris (FR)
- Hospices Civils de Lyon (FR)
- Hôpital Européen Georges-Pompidou (FR)
- Centre Hospitalier Universitaire de Nîmes (FR)
- Centre Hospitalier Universitaire de Reims (FR)
- Centre Hospitalier Universitaire de Poitiers (FR)
- Centre Hospitalier Universitaire de Caen Normandie (FR)
- Hôpital Saint Joseph (FR)
- Pitié-Salpêtrière Hospital (FR)
- Hôpital Rangueil (FR)
- Hôpitaux Universitaires Henri-Mondor (FR)
- Clinique Pasteur (FR)
- Hôpitaux Universitaires de Strasbourg (FR)
- Institut Paoli-Calmettes (FR)
- Centre Hospitalier Universitaire de Rouen (FR)
- Centre Hospitalier Universitaire de Rennes (FR)
- Bicêtre Hospital (FR)
- Hôpital Tenon (FR)
- Université d'Angers (FR)
Publication Details
- Journal
- Research Square
- Published
- 2026-11-03
- DOI
- https://doi.org/10.21203/rs.3.rs-11421886/v1
- Primary Topic
- Renal cell carcinoma treatment
- Type
- preprint