Is anatomic complexity associated with renal tumor growth kinetics under active surveillance?

Abstract

Introduction Linear growth rate (LGR) is the most commonly employed trigger for definitive intervention in patients with renal masses managed with an initial period of active surveillance (AS). Using our institutional cohort, we explored the association between tumor anatomic complexity at presentation and LGR in patients managed with AS. Methods and Materials Enhancing renal masses managed expectantly for at least 6 months were included for analysis. The association between NS and LGR was assessed using generalized estimating equations, adjusting for age, Charlson score, race, sex, and initial tumor size. Results 346 patients (401 masses) met inclusion criteria (18% ≥cT1b), with a median follow-up of 37 months (range: 6-169). 44% of patients progressed to definitive intervention with a median duration of 27 months (range: 6-130). Comparing patients managed expectantly to those requiring intervention, no difference was seen in median tumor size at presentation (2.2 vs. 2.2 cm), while significant differences in median age (74 vs. 65 years, p<0.001), Charlson co-morbidity score (3 vs. 2, p<0.001), and average LGR (0.23 vs. 0.49 cm/year, p<0.001) were observed between groups. Following adjustment, for each 1-point increase in NS sum, the average tumor LGR increased by 0.037 cm/year (p=0.002). Of the entire cohort, 6 patients (1.7%) progressed to metastatic disease. Conclusions The demonstrated association between anatomic tumor complexity at presentation and LGR of clinical stage 1 renal masses under AS may afford a clinically useful cue to tailor individual patient radiographic surveillance schedules and warrants further evaluation.

Solid Renal Masses in Transplanted Allograft Kidneys: A Closer Look at the Epidemiology and Management

“…Focal ablative therapies such as RFA or cryoablation offer alternative nephron‐sparing options for minimally invasive intervention. Whereas meta‐analysis has shown an increased local recurrence rate after RFA or cryoablation compared with partial nephrectomy , more recent data demonstrated no significant difference in local recurrence rates in a 1424‐patient cohort . Despite the limitation of a small sample size, there was a high rate of persistent viable tumor after initial RFA that required repeated treatment in this review.…”

The natural history of large renal masses followed on observation

“…15,12,16 However, others have found that growth rate is associated with sizes of renal masses on diagnosis and imaging features assessing tumor complexity. 17,18 The growth rate of renal masses followed on AS can be established from the assessment of serial imaging, which can provide valuable clinical information in a simple and non-invasive manner. Tumors exhibiting growth faster than expected may provide indications for underlying aggressive disease.…”

A nomogram for predicting cancer-specific in elderly patients with nonmetastatic renal cell carcinoma

“…Therefore, many treatments for nephrectomy (PN) and radiofrequency ablation (RFA) are widely used in clinical practice [40]. In elderly patients, the treatment of nmRCC carcinoma must consider surgical risk and comorbidity and other competing causes of death, and 20% of renal masses are pathologically diagnosed as benign [41]. Therefore, to avoid complications caused by surgical procedures, active surveillance (AS) has also begun to be used to treat clinical nmRCC.…”