The decline of radical nephrectomy: Contemporary trends in the treatment of T1 renal cell carcinoma.

Introduction: The diagnosis of small renal masses is becoming increasingly common. Management recommendations are shifting from radical nephrectomy (RN) toward nephron-sparing options such as partial nephrectomy (PN), thermal ablation (TA), and active surveillance (AS). This study aims to present current treatment trends in the USA for treating clinical stage T1 renal cell carcinoma in the largest series to date. Additionally, we sought to identify predictors linked to the receipt of ablative treatments. Methods: We conducted a retrospective cohort study using the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) 22 Registries from 2000 to 2021. Adults (≥18 years) with unilateral, primary cT1 renal cortical renal cell carcinoma were included. Treatments analysed were RN, PN, and ablative therapies (radiofrequency, cryoablation, and laser). Annual trends were assessed, and multinomial logistic regression identified demographic and clinical predictors of treatment selection. Results: A total of 86 642 patients were included. Between 2000 and 2021, PN increased from 16% to 57% and ablation from 1% to 11%, while RN decreased from 84% to 33% ( Conclusion: Over the past two decades, PN and ablation have increasingly replaced RN in the management of cT1 renal masses, particularly for tumours <4 cm. As technology advances, ablation is likely to expand further, reinforcing the shift toward nephron-sparing strategies.