Articles

Platinum Priority – Kidney Cancer
Editorial by David R. Yates and Morgan Rouprêt on pp. 45–47 of this issue

Active Surveillance of Small Renal Masses: Progression Patterns of Early Stage Kidney Cancer eulogo1

By: Michael A.S. Jewetta lowast , Kamal Mattara, Joan Basiuka, Christopher G. Morashb, Stephen E. Pautlerc, D. Robert Siemensd, Simon Tanguaye, Ricardo A. Rendonf, Martin E. Gleaveg, Darrel E. Drachenbergh, Raymond Chowi, Hannah Chunga, Joseph L. Chinj, Neil E. Fleshnera, Andrew J. Evansk, Brenda L. Galliel, Masoom A. Haiderm, John R. Kachuram, Ghada Kurbana, Kimberly Fernandesn and Antonio Finellia

European Urology, Volume 60 Issue 1, July 2011, Pages 39-44

Published online: 01 July 2011

Keywords: Active surveillance, Kidney cancer, Small renal mass

Abstract Full Text Full Text PDF (667 KB)

Abstract

Background

Most early stage kidney cancers are renal cell carcinomas (RCCs), and most are diagnosed incidentally by imaging as small renal masses (SRMs). Indirect evidence suggests that most small RCCs grow slowly and rarely metastasize.

Objective

To determine the progression and growth rates for newly diagnosed SRMs stratified by needle core biopsy pathology.

Design, setting, and participants

A multicenter prospective phase 2 clinical trial of active surveillance of 209 SRMs in 178 elderly and/or infirm patients was conducted from 2004 until 2009 with treatment delayed until progression.

Intervention

Patients underwent serial imaging and needle core biopsies.

Measurements

We measured rates of change in tumor diameter (growth measured by imaging) and progression to ≥4cm, doubling of tumor volume, or metastasis with histology on biopsy.

Results and limitations

Local progression occurred in 25 patients (12%), plus 2 progressed with metastases (1.1%). Of the 178 subjects with 209 SRMs, 127 with 151 SRMs had>12 mo of follow-up with two or more images, with a mean follow-up of 28 mo. Their tumor diameters increased by an average of 0.13cm/yr. Needle core biopsy in 101 SRMs demonstrated that the presence of RCC did not significantly change growth rate. Limitations included no central review of imaging and pathology and a short follow-up.

Conclusions

This is the first SRM active surveillance study to correlate growth with histology prospectively. In the first 2 yr, the rate of local progression to higher stage is low, and metastases are rare. SRMs appear to grow very slowly, even if biopsy proven to be RCC. Many patients with SRMs can therefore be initially managed conservatively with serial imaging, avoiding the morbidity of surgical or ablative treatment.

Take Home Message

Small renal masses (SRMs) are usually renal cell carcinomas but appear to grow very slowly. Initially, many patients with SRMs can be managed conservatively with serial imaging, avoiding the morbidity of surgical or ablative treatment.

Keywords: Active surveillance, Kidney cancer, Small renal mass.

Footnotes

a Division of Urology, Departments of Surgery and of Surgical Oncology, Princess Margaret Hospital and the University Health Network, University of Toronto, Canada

b Division of Urology, Department of Surgery, University of Ottawa, Canada

c Division of Urology, St. Joseph's Health Care London, University of Western Ontario, Canada

d Department of Urology, Queen's University, Canada

e Division of Urologic Oncology, Department of Surgery, McGill University Health Centre, Canada

f Department of Urology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Canada

g Division of Urology, The Prostate Centre, Vancouver General Hospital, Canada

h Department of Surgery, Section of Urology, University of Manitoba, Canada

i Department of Health Informatics, Princess Margaret Hospital, Canada

j Division of Urology, London Health Sciences Centre, University of Western Ontario, Canada

k Department of Pathology, Princess Margaret Hospital and the University Health Network, University of Toronto, Canada

l Ontario Cancer Institute and Princess Margaret Hospital, University of Toronto, Canada

m Department of Medical Imaging, Princess Margaret Hospital and the University Health Network, University of Toronto, Canada

n Department of Biostatistics, Princess Margaret Hospital, Canada

lowast Corresponding author. Division of Urology, University of Toronto, 610 University Avenue, 3-130, Toronto, Ontario, Canada M5G 2M9. Tel. +1 416-946-2909; Fax: +1 416-598-9997.

z.star Please visit www.eu-acme.org/europeanurology to read and answer questions on-line. The EU-ACME credits will then be attributed automatically.

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