The natural history of large renal masses followed on observation

Abstract

In highly comorbid patients, the observation of large renal masses has low likelihood for metastatic progression relative to the risk of nonkidney cancer related death. This data supports the use of surveillance as an acceptable strategy for highly selected patients with competing risks from other serious illnesses.

Association of Surgical Delay and Overall Survival in Patients With T2 Renal Masses: Implications for Critical Clinical Decision-making During the COVID-19 Pandemic

“…[7][8][9]25 or focus on poor surgical candidates undergoing observation of large renal masses. [10][11][12][13][14] Similar to our results, Mano et al retrospectively reviewed 1,278 patients at a single center and found that increasing surgical delay for renal masses >4 cm (median tumor size, 6.2 cm) was significantly associated with decreased OS after adjusting for patient and tumor characteristics. 8 Interestingly, these investigators did not find surgical delay to be associated with tumor upstaging, recurrence, or cancer-specific survival.…”

“…The literature is limited in addressing the association surgical delay with oncologic outcomes in patients with large renal masses. Published reports largely consist of retrospective single institution studies 7 , 8 , 9 , 25 or focus on poor surgical candidates undergoing observation of large renal masses 10 , 11 , 12 , 13 , 14 . Similar to our results, Mano et al retrospectively reviewed 1,278 patients at a single center and found that increasing surgical delay for renal mass >4 cm (median tumor size, 6.2cm) was significantly associated with decreased OS after adjusting for patient and tumor characteristics 8 .…”

“…Although larger renal tumors are known to harbor higher oncologic risks, it remains unclear to what extent if any, that a short to intermediate term delay in time to definitive management may impact survival. Prior studies on larger renal masses are limited by relatively small numbers from single institutions 7 , 8 , 9 or describe pre-selected patients who were poor surgical candidates 10 , 11 , 12 , 13 , 14 , 15 . There is a paucity of literature evaluating the impact of surgical delay on survival in the setting of large renal masses in contemporary patient cohorts.…”

“…Prior studies on larger renal masses are limited by relatively small numbers from single institutions [7][8][9] or describe preselected patients who were poor surgical candidates. [10][11][12][13][14][15] There is a paucity of literature evaluating the impact of surgical delay on survival in the setting of large renal masses in contemporary patient cohorts.…”

Genitourinary cancer management during a severe pandemic: Utility of rapid communication tools and evidence‐based guidelines

“…A separate study detailing the natural history of untreated cT1b tumors found that lesions which progressed to metastasis had a linear growth of 0.9 cm/year compared to 0.67 cm/year for tumors that eventually remained stable 55 . With pandemic limitation in access to elective surgical care, the data indicate that an initial short period of surveillance, with interval imaging at 3‐6 months, is safe 56 and would permit an understanding of tumor growth kinetics so as to allow proper triaging of patients with respect to need for immediate vs deferred intervention.…”