Predictors of growth kinetics and outcomes in small renal masses (SRM ≤4 cm in size): Tayside Active Surveillance Cohort (TASC) Study

C. Paterson, C. Yew-Fung, C. Sweeney, M. Szewczyk-Bieda, S. Lang, G. Nabi (Lead / Corresponding author)

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Abstract

Objective: To determine outcomes of small renal masses (≤4 cm) on active surveillance and explore factors which can influence their growth.

Patients and Methods: Two hundred twenty six patients between January 2007 and December 2014 were analysed using 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 need for interventions were secondary outcomes.

Results: 101 (64.4%) solid and 4 (5.9%) cystic SRMs showed growth. 43 (19.02%) of SRMs required treatment interventions. Seven patients (7/158; 4.4%) died due to renal cancer at a median follow-up of 21.7 (SD 10.6, min 6-42) months, all in solid category. Independent review of serial radiological imaging of these seven cases showed two patients had subtle metastatic disease at the initial presentation, and 5 of the 7 did not adhere to recommended imaging regime. 33 (33/158; 20.8%) died due to other causes including non-renal cancers (14/158; 8.8%). Multivariate analyses showed that lower eGFR at baseline, co-morbidities and tumour location were independently associated with growth in size.

Conclusions: A higher cancer-specific mortality 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.

Original languageEnglish
Pages (from-to)1589-1597
Number of pages9
JournalEuropean Journal of Surgical Oncology
Volume43
Issue number8
Early online date16 Mar 2017
DOIs
Publication statusPublished - Aug 2017

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Keywords

  • Small renal masses
  • Active surveillance
  • Co-morbidities
  • Growth patterns
  • Outcomes

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