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Predictors of growth kinetics and outcomes in small renal masses (SRM < 4 cm in size): Tayside active surveillance cohort (TASC) study.

Paterson, C.; Yew-Fung, C.; Sweeney, C.; Szewczyk-Bieda, M.; Lang, S.; Nabi, G.

Authors

C. Paterson

C. Yew-Fung

C. Sweeney

M. Szewczyk-Bieda

S. Lang

G. Nabi



Abstract

This study aimed to determine the outcomes of small renal masses ( < 4 cm) on active surveillance and to explore factors that can influence their growth. Infomation about 226 patients between January 2007 and December 2014 was analysed using a cross-linked methodology of healthcare data and independent review. Cancer-specific and non-specific survival were the primary outcomes. Growth kinetics, factors influencing growth and the need for interventions were secondary outcomes. The study found that 101 (64.4%) solid and 4 (5.9%) cystic SRMs showed growth. 43 (19.02%) of SRMs required treatment interventions. Seven patients (7 of 158; 4.4%) died due to renal cancer at a median follow-up of 21.7 (SD 10.6, min 6-42) months, all in the solid category. Independent review of serial radiological imaging of these seven cases showed that two patients had subtle metastatic disease at the initial presentation, and 5 of the 7 did not adhere to a recommended imaging regime. 33 (33 of 158; 20.8%) died due to other causes, including non-renal cancers (14 of 158; 8.8%). Multivariate analyses showed that lower eGFR at baseline, co-morbidities and tumour location were independently associated with growth in size. A higher cancer-specific mortality rate was seen in the present study compared to the reported literature. Independent critical review of imaging of cases with poor outcome underscored the importance of adherence to a robust protocol, including follow-up. Comorbid conditions had a significant impact on growth and overall survival of patients with SRMs.

Journal Article Type Article
Publication Date Aug 31, 2017
Journal European journal of surgical oncology
Print ISSN 0748-7983
Electronic ISSN 1532-2157
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 43
Issue 8
Pages 1589-1597
Institution Citation PATERSON, C., YEW-FUNG, C., SWEENEY, C., SZEWCZYK-BIEDA, M., LANG, S. and NABI, G. 2017. Predictors of growth kinetics and outcomes in small renal masses (SRM < 4 cm in size): Tayside active surveillance cohort (TASC) study. European journal of surgical oncology [online], 43(8), pages 1589-1597. Available from: https://doi.org/10.1016/j.ejso.2017.03.006
DOI https://doi.org/10.1016/j.ejso.2017.03.006
Keywords Small renal masses; Active surveillance; Comorbidities; Outcomes; Growth patterns
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