Observation Should be Considered as an Alternative in Management of Renal Masses in Older and Comorbid Patients

Beisland, Christian; Hjelle, Karin M.; Reisæter, Lars Anders Rokne; Bostad, Leif

doi:10.1016/j.eururo.2008.12.031

Cited by 84 publications

(46 citation statements)

References 27 publications

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“…We also identified 13 reports from 13 single institutional series in the global literature regarding the natural history of renal masses (Table 4) (Volpe et al 2004;Lamb et al 2004;Beisland et al 2009;Fujimoto et al 1995;Bosniak et al 1995;Oda et al 2001;Wehle et al 2004;Kato et al 2004;Abou Youssif et al 2007;Kouba et al 2007;Siu et al 2007;Fernando et al 2007;Lee et al 2008;Crispen et al 2009). Collectively, these studies were reviewed and found to account for 570 analyzable lesions.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, it has been difficult to evaluate the in vivo growth rate of the cancer in humans. However, the observation rate is increasing in the clinical management of small renal masses, especially for older patients with multiple medical comorbidities and limited life expectancies (Lamb et al 2004;Abouassaly et al 2008;Beisland et al 2009). Many review papers have been published recently on the topic of active surveillance of RCC (Chawla et al 2006;Van Poppel and Joniau 2007;Kunkle et al 2008;Mattar et al 2008;Jewett and Zuniga 2008;Cary and Sundaram 2009;Abou Youssif and Tanguay 2009).…”

Section: Discussionmentioning

confidence: 99%

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Growth pattern of renal cell carcinoma (RCC) in patients with delayed surgical intervention

Yao

Gong

et al. 2011

J Cancer Res Clin Oncol

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Growth pattern of renal cell carcinoma (RCC) in patients with delayed surgical intervention

Yao

Gong

et al. 2011

J Cancer Res Clin Oncol

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“…With emerging evidence regarding its safety, the role of AS for small RCCs has also increased. [27][28][29][30][31][32][33] In this study, AS was recommended by 21% of urologists for C3, 30% for C4, 48% for C5, and 67% for C6. …”

Section: Discussionmentioning

confidence: 99%

Surgeon-specific factors affecting treatment decisions among Canadian urologists in the management of pT1a renal tumours

Millman

Pace

Ordon

et al. 2014

CUAJ

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Introduction: The ubiquitous use of diagnostic imaging has resulted in an increased incidental detection of small renal masses (SRM). Patient-and tumour-related factors affect treatment decisions greatly; however, with multiple treatment options available, surgeonspecific characteristics and biases may also influence treatment recommendations. We determine the impact of surgeon-specific factors on treatment decisions in the management of SRM in Canada. Methods: An online survey study was conducted among Canadian urologists currently registered with the Canadian Urological Association. The questionnaire collected demographic information and recommended treatments for 6 SRM index cases involving theoretical patients of various ages (51-80 years) and comorbidities. Results: A total of 110 urologists responded (17% response rate) to the survey. Of these, 18% were over 65 years old and 45% were from academic centres. With increasing patient age and comorbidity, active surveillance and thermal ablative therapies were more the recommended treatment. Laparoscopic/robotic surgery was more commonly recommended by academic urologists and those under 65. Recommending surgery (radical nephrectomy or partial nephrectomy) for both elderly (about 80 years old) index patients correlated with surgeon age (surgeons over 65, p < 0.001), surgeons with no oncologic fellowship training (p = 0.021), surgeons with a non-academic practice (p = 0.003), surgeons with a personal history of cancer (p = 0.038) and surgeons with a family history of cancer death in the last 10 years (p = 0.022). Conclusions: There are various factors that influence the management options offered to patients with SRMs. Our results suggest that surgeon age, personal history of cancer, practice-type and other surgeon-specific variables may affect treatments offered among urologists across Canada.

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“…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].…”

Section: Discussionmentioning

confidence: 99%

“…Given the rising incidence of incidentally diagnosed SRM that may potentially have a non-malignant clinical course [21], AS represents a primary treatment option for patients at high surgical risk or limited life expectancy according to American and European guidelines [3,22]. 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].…”

Section: Discussionmentioning

confidence: 99%

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

Becker

Roghmann²,

Ravi³

et al. 2014

Urol Int

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Objective: To examine the impact of nephrectomy delay on the survival of patients with small renal masses. Methods: Relying on the Surveillance, Epidemiology, and End Results Medicare-linked database, 6,237 patients with pT1a renal cell carcinoma who underwent radical or partial nephrectomy were identified (1988-2005). Nephrectomy delay was dichotomized as ≤3 vs. >3 months. Uni- and multivariate Cox regression analyses tested the effect of delayed nephrectomy on cancer-specific mortality (CSM). In sub-analyses, various other time from diagnosis to nephrectomy cut-offs were modelled: (a) ≤1 vs. >1 month, (b) ≤2 vs. >2 months, (c) ≤4 vs. >4 months, (d) ≤6 vs. >6 months, (e) ≤12 vs. >12 months or (f) continuously coded. Results: In univariate analyses, nephrectomy delay >3 months was associated with a higher risk of CSM (hazard ratio [HR]: 2.07; 95% confidence interval [CI]: 1.58-2.72; p < 0.001). However, after multivariate adjustment, a nephrectomy delay >3 months was not significantly associated with a higher risk of CSM (HR: 1.33; 95% CI: 0.96-1.86; p = 0.09). The lack of a relationship between nephrectomy delay and CSM after multivariate adjustment persisted even in various sub-analyses of other categorizations for nephrectomy delay. Conclusions: In the case of eventual nephrectomy delay among patients with small renal masses, CSM is unaffected.

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Observation Should be Considered as an Alternative in Management of Renal Masses in Older and Comorbid Patients

Cited by 84 publications

References 27 publications

Growth pattern of renal cell carcinoma (RCC) in patients with delayed surgical intervention

Growth pattern of renal cell carcinoma (RCC) in patients with delayed surgical intervention

Surgeon-specific factors affecting treatment decisions among Canadian urologists in the management of pT1a renal tumours

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

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