Active surveillance for incidental renal mass in the octogenarian

To evaluate the oncologic outcomes among a large cohort of octogenarian patients placed on active surveillance for a localized renal mass.

We retrospectively reviewed patients ≥80 years of age presenting for asymptomatic, incidentally detected clinically localized stage T1 renal mass between 2006 and 2013 who were followed by active surveillance (AS). The primary endpoint was development of metastatic renal cell carcinoma. Secondary outcomes included intervention-free survival, cancer-specific survival, and overall survival.

Eighty-nine octogenarians (median age = 83.4 years) were placed on AS for a median 29.9 months. Median Charlson Comorbidity Index and Katz Index of Independence in Activities of Daily Living scores were 2 and 5, respectively. For all comers, median initial tumor size was 2.4 cm with median growth rate of 0.20 cm/year. Eight (9.0%) patients failed AS due to delayed intervention and three (1.1%) due to systemic progression after median follow-up of 27.8 and 39.9 months, respectively. Two (2.2%) patients in the delayed intervention cohort developed metastasis after treatment. Tumor growth rate was significantly higher among those undergoing intervention versus no intervention (0.60 vs. 0.15 cm/year, P = 0.05) and among patients with systemic progression versus no metastasis (1.28 vs. 0.18 cm/year, P = 0.001). Five-year intervention-free, metastasis-free, cancer-specific, and overall survivals were 90.6, 95.6, 95.6, and 85.7%, respectively.

AS represents an effective management strategy in octogenarians given low overall risk of metastasis. Tumor growth kinetics may identify patients at risk of systemic progression in whom treatment should be considered.

World journal of urology. 2016 Nov 01 [Epub ahead of print]

Kenan E Celtik, Paras H Shah, Vinay R Patel, Daniel M Moreira, Arvin K George, Valerio Iacovelli, Manaf Alom, Andrew Ng, Amin Herati, Simpa S Salami, Hannah Bierwiler, Michael J Schwartz, Lee Richstone, Joph Steckel, Manish A Vira, Louis R Kavoussi

Department of Urology, The Arthur Smith Institute for Urology, Northwell Health, 450 Lakeville Road, Suite M41, New Hyde Park, NY, 11040, USA. ., Department of Urology, The Arthur Smith Institute for Urology, Northwell Health, 450 Lakeville Road, Suite M41, New Hyde Park, NY, 11040, USA., Department of Urology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55902, USA., Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, Building 10 Room 1-5940, Bethesda, MD, 20892, USA., Department of Urology, Baylor College of Medicine, 7200 Cambridge St #10B, Houston, TX, 77030, USA., Department of Urology, University of Michigan, 1500 E. Medical Center Drive, SPC 5330, Ann Arbor, MI, 48109-5330, USA.

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