Role of Active Surveillance for Localized Small Renal Masses

Maria Carmen Mir, Umberto Capitanio, Riccardo Bertolo, Idir Ouzaid, Maciej Salagierski, Maximilian Kriegmair, Alessandro Volpe, Michael A.S. Jewett, Alexander Kutikov, Phillip M. Pierorazio

Research output: Contribution to journalReview articlepeer-review

Abstract

Context: Stage migration of organ-confined renal masses is occurring as a result of incidental diagnosis, especially in the elderly. Active surveillance (AS) is gaining clinical traction as a treatment alternative to surgery and focal therapy. Objective: To assess contemporary data and evaluate AS risk trade-offs in the treatment of organ-confined kidney cancer. Evidence acquisition: A comprehensive search of the Embase, Medline and Cochrane databases was carried out. A systematic review of the role of AS for organ-confined renal masses was performed. A total of 28 studies were included in the systematic review. Evidence synthesis: The median linear tumor growth rate for clinically localized renal masses (CLRMs) was 0.37 cm/yr (interquartile range 0.15–0.7), with 0.22 cm/yr in the cT1a subgroup and 0.45 cm/yr in the cT1b––2 subgroup. The metastatic progression rate was 1–6% and was similar for cT1a (1–6%) and cT1b (0–5%); other-cause mortality for patients with CLRMs was 0–45% (1–25% for cT1a vs 11–13% for cT1b–2); cancer-specific mortality ranged between 0% and 18%. According to the 2011 Oxford scale, AS as a treatment option for CLRMs remains supported by level 3 evidence. Conclusions: Although no randomized clinical data are available, current data support oncologic safety for AS in the management of CLRMs, particularly for small renal masses and among elderly and/or comorbid patients. Patient summary: In this review we looked at the outcomes for patients with small kidney masses managed with surveillance. We found that surveillance is a safe initial option for tumors of less than 2 cm, especially in elderly and sick patients. Active surveillance for clinically localized renal masses is a safe initial option, especially for masses of <2 cm in elderly and sick patients. Further investigation to establish active surveillance protocols and follow-up are still missing. Prospective nonrandomized registry collection of data for patients with small renal masses is ongoing.

Original languageEnglish (US)
Pages (from-to)177-187
Number of pages11
JournalEuropean Urology Oncology
Volume1
Issue number3
DOIs
StatePublished - Aug 2018

Keywords

  • Active surveillance
  • Kidney cancer
  • Renal mass
  • Watchful waiting

ASJC Scopus subject areas

  • Surgery
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Urology

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