Small renal masses (SRMs; tumors <4 cm) encompass a diagnostic and therapeutic challenge. Genomic profiling has the potential to improve risk stratification and personalize treatment selection.
Herein, we review the evidence regarding the utility, challenges, and potential implications of genomic profiling in the management of SRMs.
Pertinent publications available on PubMed database pertaining to kidney cancer, tumor size, genomics, and clinical management were reviewed.
Compared with larger tumors, SRMs range from benign to lethal, necessitating strategies for improved treatment selection. Recent advances in the molecular characterization of renal cell carcinoma have improved our understanding of the disease; however, utility of these tools for the management of SRMs is less clear. While intratumoral heterogeneity (ITH) reduces the accuracy and reliability of sequencing, relative genomic uniformity of SRMs somewhat lessens the impact of ITH. Therefore, renal mass biopsy of SRMs represents an appealing opportunity to evaluate how incorporation of molecular profiles may improve management strategies.
Ongoing research into the genomic landscape of SRMs has advanced our understanding of the spectrum of disease aggressiveness and may hold promise in matching disease biology to treatment intensity.
Small renal masses are a clinical challenge, as they range from benign to lethal. Genomic profiling may eventually improve treatment selection, but more research is needed.
European urology focus. 2019 Apr 27 [Epub ahead of print]
Andrew W Silagy, Alejandro Sanchez, Brandon J Manley, Karim Bensalah, Axel Bex, Jose A Karam, Börje Ljungberg, Brian Shuch, A Ari Hakimi
Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Surgery, University of Melbourne, Austin Hospital, Melbourne, Victoria, Australia., Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA., Moffitt Cancer Center Genitourinary Oncology and Integrated Mathematical Oncology, Tampa, FL, USA., Department of Urology, University of Rennes, Rennes, France., Royal Free London NHS Foundation Trust and UCL Division of Surgery and Interventional Science, London, UK; The Netherlands Cancer Institute, Amsterdam, The Netherlands., Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA., Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden., UCLA School of Medicine, Los Angeles, CA, USA., Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA. Electronic address: .