BACKGROUND: Radiofrequency ablation (RFA) and cryoablation are minimally invasive treatments for renal cell carcinoma (RCC). However, their comparative efficacy remains under evaluation. This study aims to compare overall survival (OS) and cancer-specific survival (CSS) outcomes using data from the Surveillance, Epidemiology, and End Results (SEER) database. METHODS: This retrospective cohort study included patients diagnosed with T1a-bN0M0 RCC from the SEER database (2004-2018). Propensity score matching was used to control for confounders, including age, sex, and tumor characteristics. Cox proportional hazards regression was applied to assess OS and CSS. RESULTS: A total of 3768 patients were analyzed, including 3499 with T1a and 269 with T1b tumors. Patients aged >
65 years and those with T1b tumors exhibited significantly lower OS and CSS (P <
0.002). RFA was associated with reduced OS compared to cryoablation (P = 0.012). Multivariate analyses further confirmed that elderly patients, particularly those with T1b tumors, experienced worse OS (P = 0.0104) and CSS (P = 0.008) following RFA compared to cryoablation. Subgroup and competing risk analyses consistently demonstrated lower cumulative mortality in the cryoablation group. CONCLUSIONS: Cryoablation offers superior survival outcomes compared to RFA for T1a and T1b RCC, particularly in elderly patients. These findings support cryoablation as the preferred minimally invasive treatment for early-stage kidney cancer.