Long-term surveillance safe for small renal tumors in elders

  • Whelan EA & al.
  • J Urol
  • 1 Jul 2019

  • curated by Deepa Koli
  • Univadis Clinical Summaries
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Takeaway

  • Small renal masses in elderly patients on active surveillance display indolent behavior in the long term, with a low rate of progression to metastatic disease.
  • Nearly 46% of patients died of other causes.

Why this matters

  • Active surveillance appears to be safe in patients at high risk for the morbidity of active treatment.
  • High other-cause mortality rate throughout follow-up indicates that active treatment would not be beneficial in these patients.

Study design

  • 103 patients (median age, 75 years) with 107 renal masses undergoing active surveillance of small renal masses diagnosed between 2001 and 2011.
  • Median maximum diameter and volume at diagnosis were 2.1 cm and 4.8 cm3, respectively.
  • Outcomes: progression to treatment, metastatic disease, and/or death.
  • Funding: None disclosed.

Key results

  • Median follow-up was 55.5 months.
  • Disease metastasis was reported in 1.9% of patients, and 1.0% died of renal cell carcinoma.
  • The mean linear and volumetric growth rates of renal masses were 0.21 cm per year and 6.15 cm3 per year, respectively.
  • 51.5% of patients remained on active surveillance and 46.6% died of other causes.

Limitations

  • Small observational study.
  • Lack of biopsy reports.

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