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.

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.

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

• Journal Article Type: Article
• Acceptance Date: Mar 9, 2017
• Online Publication Date: Mar 16, 2017
• Publication Date: Aug 31, 2017
• Deposit Date: Apr 14, 2017
• Publicly Available Date: Mar 17, 2018
• 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
• DOI: https://doi.org/10.1016/j.ejso.2017.03.006
• Keywords: Small renal masses; Active surveillance; Comorbidities; Outcomes; Growth patterns
• Public URL: http://hdl.handle.net/10059/2911