STOCKHOLM, SWEDEN (UroToday.com) - Enthusiasm for active surveillance of small renal masses (SRMs) is tempered by the existence of patients with T1a masses who present with metastatic disease.
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Recently, and in part due to the existence of such patients, some thought leaders in the field have advocated for more aggressive treatment strategies for SRMs. The authors' objective was to compare characteristics of patients with T1a SRMs who present with localized vs metastatic RCC. To answer the question, two large administrative U.S. databases were used, SEER (surveillance, epidemiology and end results) and NCDB (national cancer database). Approximately 52 000 and 87 400 patients from SEER and NCDB, respectively, with T1a RCC diagnosed between 1988 and 2010 were included. Clinicopathological variables, cancer specific, and overall survival were compared between patients presenting with or without metastatic disease.
Within SEER, 5.1% of SRM patients presented with metastatic disease. At a mean follow-up of 4.7 years, 5-year cancer specific death rates were, as expected, markedly higher in patients presenting with metastases. Patients presenting with metastatic disease were more commonly male, not married, older, had higher grade and larger tumors. Within the NCDB, even fewer SRM patients presented with metastatic disease (2.0%). Patients presenting with metastatic disease were older, more commonly male, more comorbid, more likely insured with Medicare, high larger and higher grader tumors, and more likely treated at community or comprehensive community centers as opposed to academic centers. Following adjustment, in patients with small renal tumours the risks of overall and cancer specific mortality were 5.0 and 17.2 times higher, respectively, in patients presenting with metastatic disease.
In conclusion, patients with T1a SRM who present with metastatic disease represent a minority (approximately 2-5%) of patients with malignant SRM. While SRM patients presenting with metastases present a potential opportunity for better understanding of RCC biology, they should not necessarily bias management of localized SRM cohorts.
Click HERE to listen to Jeffrey J. Tomaszewski, MD discuss this study
Presented by Jeffrey J. Tomaszewski, MD at the 29th Annual European Association of Urology (EAU) Congress - April 11 - 15, 2014 - Stockholmsmässan - Stockholm, Sweden.
Fox Chase Cancer Center, Department of Surgical Oncology, Philadelphia, USA
Written by Jeffrey J. Tomaszewski, MD, medical writer for UroToday.com
EAU 2014, small renal mass (SRM), SEER database, national cancer database (NCDB)