Management of Localized Kidney Cancer: Calculating Cancer-specific Mortality and Competing Risks of Death for Surgery and Nonsurgical Management

Contemporary incidence and mortality rates of kidney cancer in the United States

“…As the incidence and mortality rates of localized RCC continues to rise, it becomes essential for physicians to better select candidates who will benefit from active treatment, and sparing those for which treatment would be unnecessary. 26 Indeed, a previous review showed that most small renal masses remain radiographically static after an initial period of surveillance. 28 The improved selection of surgical candidates may depend on the identification of biomarkers that can help distinguish benign and malignant disease, as well to accurately predict tumours that will metastasize.…”

“…While overtreatment is non-negligible in the context of small renal masses, 25 the clinical dilemma persists, as some patients diagnosed with small renal masses do not live long enough to benefit from surgery, while others may harbour an aggressive disease phenotype that physicians are unable to reliably identify. 26 Existing data indicate that especially among patients with competing health risks, active surveillance is a suitable approach, 25,26 where a delayed intervention would not jeopardize the window of curability. 27 From a clinical standpoint, our results raise significant considerations.…”

Delay in Nephrectomy and Cancer Control Outcomes in Elderly Patients with Small Renal Masses

“…The slow growth rate [6,9,21] and low risk of systemic progression [4,11,12] of SRM as well as the high perioperative morbidity and mortality of surgery may outweigh the possible oncologic benefit of surgical intervention, particularly in older and sicker patients [23,24]. Nevertheless, 15-51% of patients initially managed by AS eventually undergo nephrectomy [6,9,14] as a result of tumor growth (38%), improvement in health status (9%), patient preference (11%) or physician recommendation for definitive treatment (41%) [6].…”

The Nephrologist’s Tumor: Basic Biology and Management of Renal Cell Carcinoma

“…81 Furthermore, the use of active surveillance when tumor size was monitored closely and regularly, with surgical treatment as required, has also been shown to be effective and comparable with surgical resection, particularly for the elderly (age .75 years old) and in select populations. 82 Surveillance of localized SRMs (T1 staging) after definitive treatment is recommended by the American Urological Association at baseline, within 3-12 months with abdominal imaging (computed tomography or magnetic resonance imaging) after RN or PN, and yearly (computed tomography, magnetic resonance imaging, or ultrasonography) for 3 years (time of highest recurrence risk) after PN, with chest radiography also suggested yearly for 3 years or longer if clinically indicated. For those who have received ablative therapies, abdominal imaging and chest radiography are suggested yearly for 5 years.…”