Objective:

To examine the association between ablative therapy (AT) or partial nephrectomy (PN) treatment and the occurrence of local recurrence (LR), distant metastatic recurrence (DMR), and all-cause mortality (ACM) in a population-based cohort of patients with localized nonmetastatic renal cell carcinoma (nmRCC), highlighting the significance of these associations in clinical practice.

Key Findings:

• Local recurrence (LR) occurred in 4.0% of tumors, while distant metastatic recurrence (DMR) occurred in 3.9%, indicating a low but significant risk.
• Death without LR/DMR was observed in 7.5% of cases, suggesting a notable mortality rate in this cohort.
• Patients treated with AT were older and had smaller tumors compared to those treated with PN, which may influence treatment outcomes.

Interpretation:

The study highlights the risks of LR and DMR associated with nephron-sparing treatments for nmRCC, suggesting that treatment choice may influence recurrence rates and mortality, with implications for clinical decision-making.

Limitations:

• The study is observational and may be subject to biases inherent in registry data, which could affect the generalizability of the findings.
• Follow-up duration varied, potentially affecting recurrence detection and the reliability of long-term outcome assessments.

Conclusion:

Both AT and PN have associated risks for LR and DMR in nmRCC patients, with treatment choice impacting outcomes. Further research is needed to define optimal salvage procedures after treatment failure, emphasizing the importance of ongoing investigation in this area.