TY - JOUR
T1 - Role of Active Surveillance for Localized Small Renal Masses
AU - Mir, Maria Carmen
AU - Capitanio, Umberto
AU - Bertolo, Riccardo
AU - Ouzaid, Idir
AU - Salagierski, Maciej
AU - Kriegmair, Maximilian
AU - Volpe, Alessandro
AU - Jewett, Michael A.S.
AU - Kutikov, Alexander
AU - Pierorazio, Phillip M.
N1 - Publisher Copyright:
© 2018 European Association of Urology
PY - 2018/8
Y1 - 2018/8
N2 - Context: 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. Objective: To assess contemporary data and evaluate AS risk trade-offs in the treatment of organ-confined kidney cancer. Evidence acquisition: 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. Evidence synthesis: The median linear tumor growth rate for clinically localized renal masses (CLRMs) was 0.37 cm/yr (interquartile range 0.15–0.7), with 0.22 cm/yr in the cT1a subgroup and 0.45 cm/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. Conclusions: 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. Patient summary: 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 2 cm, especially in elderly and sick patients. Active surveillance for clinically localized renal masses is a safe initial option, especially for masses of <2 cm in elderly and sick patients. Further investigation to establish active surveillance protocols and follow-up are still missing. Prospective nonrandomized registry collection of data for patients with small renal masses is ongoing.
AB - Context: 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. Objective: To assess contemporary data and evaluate AS risk trade-offs in the treatment of organ-confined kidney cancer. Evidence acquisition: 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. Evidence synthesis: The median linear tumor growth rate for clinically localized renal masses (CLRMs) was 0.37 cm/yr (interquartile range 0.15–0.7), with 0.22 cm/yr in the cT1a subgroup and 0.45 cm/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. Conclusions: 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. Patient summary: 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 2 cm, especially in elderly and sick patients. Active surveillance for clinically localized renal masses is a safe initial option, especially for masses of <2 cm in elderly and sick patients. Further investigation to establish active surveillance protocols and follow-up are still missing. Prospective nonrandomized registry collection of data for patients with small renal masses is ongoing.
KW - Active surveillance
KW - Kidney cancer
KW - Renal mass
KW - Watchful waiting
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U2 - 10.1016/j.euo.2018.05.001
DO - 10.1016/j.euo.2018.05.001
M3 - Review article
C2 - 31102618
AN - SCOPUS:85054612753
SN - 2588-9311
VL - 1
SP - 177
EP - 187
JO - European Urology Oncology
JF - European Urology Oncology
IS - 3
ER -