Small Renal Masses Managed With Active Surveillance: Predictors of Tumor Growth Rate After Long-Term Follow-Up

Schiavina, Riccardo; Borghesi, Marco; Dababneh, Hussam; Bianchi, Lorenzo; Longhi, Barbara; Diazzi, Davide; Monti, Carlo; Manna, Gaetano La; Martorana, Giuseppe; Brunocilla, Eugenio

doi:10.1016/j.clgc.2014.08.006

Cited by 32 publications

(39 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In the study by Schiavina et al, the size was not a significant predictor of growth kinetics. 57 Similar results have been reported by others.…”

Section: Predictive Factors Of Renal Tumor Aggressiveness and Growth supporting

confidence: 82%

“…Interestingly, male sex was found to be a significant predictor of tumor growth rate in both the overall cohort of patients (HR 1.70, P = 0.04) and AS subgroup (HR 1.78, P = 0.03). 57 Similarly, symptomatic tumors at the time of diagnosis showed faster growth rates than the counterparts in the overall patient population (HR 1.85, P = 0.02), in the AS and delayed surgery group (HR 1.92 and 1.82, respectively; P = 0.02). 57 Matsumoto et al, in their retrospective, single-institutional study, showed the results of 47 patients diagnosed with SRM scheduled for AS or surgery, with a median follow up of 24 months.…”

Section: Predictive Factors Of Renal Tumor Aggressiveness and Growth mentioning

confidence: 99%

“…57 Similarly, symptomatic tumors at the time of diagnosis showed faster growth rates than the counterparts in the overall patient population (HR 1.85, P = 0.02), in the AS and delayed surgery group (HR 1.92 and 1.82, respectively; P = 0.02). 57 Matsumoto et al, in their retrospective, single-institutional study, showed the results of 47 patients diagnosed with SRM scheduled for AS or surgery, with a median follow up of 24 months. 58 In that report, male sex was not significantly associated with faster tumor growth rates.…”

Section: Predictive Factors Of Renal Tumor Aggressiveness and Growth mentioning

confidence: 99%

See 2 more Smart Citations

Active surveillance for clinically localized renal tumors: An updated review of current indications and clinical outcomes

et al. 2015

Self Cite

View full text Add to dashboard Cite

The widespread use of abdominal imaging has led to an increasing detection of small renal masses, and approximately 20-30% of those tumors will prove to be benign, with low metastatic potential if not immediately treated. In elderly or comorbid patients diagnosed with small renal masses, competing cause mortality seems to exceed cancer-specific mortality at short-and intermediate-term follow up. In these cases, surgery might represent an overtreatment, and an expectant management, such as active surveillance, might be proposed. According to the current available evidence, active surveillance is a safe and reasonable option for patients with renal tumors 4 cm (cT1a) and short life expectancy. A few studies with short-term follow up reported the preliminary results of active surveillance even in cT1b-cT2 tumors, with acceptable risk of disease progression and mortality, even if this approach should be considered in this setting only for highly-selected and wellinformed patients. Furthermore, surveillance protocols can be proposed in selected patients with uncomplicated benign tumors, such as angiomyolipomas, in which active surveillance should be considered the initial standard management. At present, reliable clinical predictors of a tumor's growth rate and aggressiveness are not available. Renal tumor biopsy is useful in the clinical work-up of patients who are candidates for active surveillance, in order to improve patient selection based on tumor histological characterization. Despite the proof of safety offered by expectant management for small renal masses in selected patients, further prospective studies with longer follow up are required in order to confirm the indications and long-term oncological outcomes of active surveillance protocols for renal tumors.

show abstract

“…In the study by Schiavina et al, the size was not a significant predictor of growth kinetics. 57 Similar results have been reported by others.…”

Section: Predictive Factors Of Renal Tumor Aggressiveness and Growth supporting

confidence: 82%

Section: Predictive Factors Of Renal Tumor Aggressiveness and Growth mentioning

confidence: 99%

Section: Predictive Factors Of Renal Tumor Aggressiveness and Growth mentioning

confidence: 99%

See 1 more Smart Citation

Active surveillance for clinically localized renal tumors: An updated review of current indications and clinical outcomes

et al. 2015

Self Cite

View full text Add to dashboard Cite

show abstract

“…Especially in elderly and frail patients their management remains controversial, since 20-30% are benign lesions and the metastatic risk is very low [3] . In recent years, this has led to a wider acceptance of surveillance strategies instead of surgical removal of tumours [2,4] . In case of surgical removal, partial nephrectomy should be preferred [5] .…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Plasmatic Kisspetin-10 as a Biomarker for Malignancy and Subtype Differentiation in Small Renal Tumours

Horstmann

Krause²,

Steinbach³

et al. 2017

Urol Int

View full text Add to dashboard Cite

Objective: To evaluate Kisspeptin-10 (Kiss-10) in patients with small renal tumours (SRTs) and controls. Material and Methods: Kiss-10 was measured in preoperative plasma samples in a cohort of 143 patients with unilateral renal tumours smaller than or equal to 4 cm and 40 age-matched controls by a competitive ELISA test kit. The cohort of patients included 56 patients with clear cell renal cell carcinoma (ccRCC), 43 with papillary RCC (pRCC), 12 with chromophobe RCC (chRCC) and 32 with oncocytomas. Results: Kiss-10 was detected in all patients and controls. SRT patients revealed significantly higher Kiss-10 levels than controls (mean value 10.04 vs. 6.37 pmol/l, p < 0.001). In SRT patients, Kiss-10 was detected at significantly different concentrations between the subgroups (p = 0.021). The highest concentration was observed in those with oncocytomas (11.50 pmol/) followed by chRCC, pRCC and ccRCC patients (9.89, 10.01 and 9.25 pmol/l, respectively). Receiver operating characteristic curve analyses revealed an area under the curve (AUC) of 0.82 for the comparison of all tumours vs. controls (p < 0.001) and an AUC of 0.671 for all malignant tumours vs. oncoytomas (p = 0.003). Conclusion: This study shows that Kiss-10 levels are significantly altered by malignancy and tumour subtypes even in patients with SRTs. Kiss-10 therefore deserves further attention as a plasmatic biomarker for renal tumours.

show abstract

“…2 Patients in general must be relatively healthy and fit to undergo surgery, but many are not offered surgery due to advanced age or medical comorbidities. In these patients, active surveillance is one management option; 3 however it may not be desirable if there is evidence of fast growth kinetics, 4 in association with male gender, symptomatic disease, younger age, and tumours >2.5 cm. 5 For small T1a RCCs, ablative percutaneous techniques, such as cryotherapy, microwave ablation and radiofrequency ablation, are alternative strategies.…”

Section: Introductionmentioning

confidence: 99%

Stereotactic body radiotherapy for the treatment of medically inoperable primary renal cell carcinoma: Current evidence and future directions

Swaminath

Chu

2015

CUAJ

View full text Add to dashboard Cite

The incidence of renal cell carcinoma (RCC) is steadily rising due to an aging population and more frequent imaging of the abdomen for other medical conditions. While surgery remains the standard of care treatment for localized disease, many patients are unfit due to their advanced age and medical comorbidities. In these patients, an active surveillance strategy or ablative therapies, including radiofrequency/microwave ablation or cryotherapy, can be offered. Such options have limitations particularly with fast growing, or larger tumors. A promising ablative therapy option to consider is stereotactic body radiotherapy (SBRT). SBRT refers to high dose, focally ablative radiation delivered in a short time (3-5 fractions), and is safe and effective in many other cancer sites, including lung, liver and spine. SBRT offers potential advantages in the primary kidney cancer setting due to its ablative dosing (overcoming the notion of "radio-resistance"), short treatment duration (important in an elderly population), low toxicity profile (enabling SBRT to treat larger RCCs than other ablative modalities), and non-invasiveness. To date, there is limited long-term prospective data on the outcomes of SBRT in primary RCC. However, early evidence is intriguing with respect to excellent local control and low toxicity; however, most studies vary in terms of technique and radiation dosing used. Welldesigned prospective cohort studies with clearly defined and standardized techniques, dosing, follow-up, and integration of quality of life outcomes will be essential to further establish the role of SBRT in management of inoperable, localized RCC.

show abstract

Small Renal Masses Managed With Active Surveillance: Predictors of Tumor Growth Rate After Long-Term Follow-Up

Cited by 32 publications

References 20 publications

Active surveillance for clinically localized renal tumors: An updated review of current indications and clinical outcomes

Active surveillance for clinically localized renal tumors: An updated review of current indications and clinical outcomes

Evaluation of Plasmatic Kisspetin-10 as a Biomarker for Malignancy and Subtype Differentiation in Small Renal Tumours

Stereotactic body radiotherapy for the treatment of medically inoperable primary renal cell carcinoma: Current evidence and future directions

Contact Info

Product

Resources

About