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.
To assess contemporary data and evaluate AS risk trade-offs in the treatment of organ-confined kidney cancer.
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.
The median linear tumor growth rate for clinically localized renal masses (CLRMs) was 0.37cm/yr (interquartile range 0.15-0.7), with 0.22cm/yr in the cT1a subgroup and 0.45cm/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.
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.
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 2cm, especially in elderly and sick patients.
European urology oncology. 2018 May 26 [Epub]
Maria Carmen Mir, Umberto Capitanio, Riccardo Bertolo, Idir Ouzaid, Maciej Salagierski, Maximilian Kriegmair, Alessandro Volpe, Michael A S Jewett, Alexander Kutikov, Phillip M Pierorazio, Young Academic Urologists Kidney Cancer working group of the European Urological Association
Department of Urology, Fundación Instituto Valenciano de Oncologia, Valencia, Spain. Electronic address: ., Department of Urology, San Raffaele Scientific Institute, Milan, Italy; Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS San Raffaele Hospital, Milan, Italy., Division of Urology, Department of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Turin, Italy., Department of Urology, Bichat Hospital, APHP, Paris Diderot University, Paris, France., Urology Department, University of Zielona Góra, Zielona Góra, Poland., Department of Urology, University Medical Centre Mannheim, Mannheim, Germany., Department of Urology, University of Novara, Maggiore della Carità Hospital, Novara, Italy., Departments of Surgery (Urology) and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada., Division of Urologic Oncology, Fox Chase Cancer Center, Temple Health System, Philadelphia, PA, USA., James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.