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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.

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 EJSO - 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