Conditional survival of patients with small renal masses undergoing active surveillance

Petros, Firas; Venkatesan, Aradhana M.; Kaya, Diana; Ng, Chaan S.; Fellman, Bryan; Karam, Jose A.; Wood, Christopher G.; Peng, Jiaqi

doi:10.1111/bju.14486

Cited by 16 publications

(15 citation statements)

References 29 publications

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“…The risk for DI was shown to be mainly influenced by growth rate and initial size of tumour rather than the results of initial renal biopsy (26). This mirrors the finding of reasons for delayed intervention from two AS studies included in this review and other studies, with patient and clinician choice being the major decider rather than progression on imaging (4,20,30,31).…”

Section: Role Of Renal Mass Biopsysupporting

confidence: 60%

“…We identified 181 unique citations; of these 144 were excluded after review of the abstract due to reasons of: not containing the population of interest, study period starting before 2000, review articles, commentaries or studies without relevant clinical data on both patient characteristics and outcomes. Full text screening was carried out in 37 articles, of which 21 were excluded, resulting in 16 included articles (of which 2 are conference abstracts) covering 13 different patient cohorts represented in 15 studies (15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30). Numerous studies have been published using the large United States datasets of DISSRM (Delayed Intervention and Surveillance for Small Renal Masses registry) (31-36), SEER (Surveillance, Epidemiology and End Results program) (37)(38)(39)(40)(41) and the National Cancer Database (42,43), of which, the most relevant articles for this review have been chosen.…”

Section: Search Results Of Studies Pertaining To Worldwide Practicementioning

confidence: 99%

“…AS, active surveillance; CT, computed tomography; DI, delayed intervention; GR, growth rate; MRI, magnetic resonance imaging; PN, partial nephrectomy; RCC, renal cell carcinoma; RN, radical nephrectomy; SRM, small renal mass; US, ultrasound.of Toronto(19), DISSRM (20), Oxford (23), University of Michigan 2016(15), MD Anderson (30)] stated patient preference as a reason for DI, with proportions of DI due to patient preference varying from 11% to 71%. The MD Anderson study(30) also found that patient choice was the most common reason for DI within the first two years of AS, whereas increasing size was the most common reason after 2 years of AS. Increase in size or meeting progression criteria as the reason for DI varied from 29% to 100% of DI cases.…”

mentioning

confidence: 93%

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Surveillance for low-risk kidney cancer: a narrative review of contemporary worldwide practices

Cui

Sullivan

2021

Transl Androl Urol

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The management trend of low-risk kidney cancer over the last decade has been from treatment with radical nephrectomy, to use of nephron sparing procedures of partial nephrectomy and ablation, as well as the option of active surveillance (AS). This narrative review aims to summarise the available guidelines related to AS and review the published descriptions of regional practices on the management of low-risk kidney cancer worldwide. A search of PubMed, Google Scholar and Cochrane Library databases for studies published 2010 to June 2020 identified 15 studies, performed between 2000 and 2019, which investigated 13 different cohorts of low-risk kidney cancer patients on AS. Although international guidelines show a level of agreement in their recommendation on how AS is conducted, in terms of patient selection, surveillance strategy and triggers for intervention, cohort studies show distinct differences in worldwide practice of AS. Prospective studies showed general agreement in their predefined selection criteria for entry into AS.Retrospective studies showed that patients who were older, with greater comorbidities, worse performance status and smaller tumours were more likely to be managed with AS. The rate of percutaneous renal mass biopsy varied between studies from 2% to 56%. The surveillance protocol was different across all studies in terms of recommended modality and frequency of imaging. Of the 6 studies which had set indications for intervention, these were broadly in agreement. Despite clear criteria for intervention, patient or surgeon preference was still the reason in 11-71% of cases of delayed intervention across 5 studies. This review shows that AS is being applied in a variety of centres worldwide and that key areas of patient selection criteria and surveillance strategy have large similarities. However, the rate of renal mass biopsy and of delayed intervention varies significantly between studies, suggesting the process of diagnosing malignant SRM and decision making whilst on AS are varying in practice. Further research is needed on the diagnosis and characterisation of incidentally found small renal masses (SRM), using imaging and histology, and the natural history of these SRM in order to develop evidence-based active surveillance protocols.

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Section: Role Of Renal Mass Biopsysupporting

confidence: 60%

Section: Search Results Of Studies Pertaining To Worldwide Practicementioning

confidence: 99%

mentioning

confidence: 93%

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Surveillance for low-risk kidney cancer: a narrative review of contemporary worldwide practices

Cui

Sullivan

2021

Transl Androl Urol

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“…Of these, 474 were excluded by title and abstract screening, while 68 were selected for full-text assessment of eligibility. Of these records, 19 studies fulfilling all PICOS criteria were included in the qualitative analysis [19,20,[26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42], while 18 were included in the quantitative analysis (Fig. S1).…”

Section: Study Selectionmentioning

confidence: 99%

Intermediate‐ and long‐term oncological outcomes of active surveillance for localized renal masses: a systematic review and quantitative analysis

et al. 2021

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To evaluate intermediate-and long-term oncological outcomes of active surveillance (AS) for localized renal masses (LRMs). MethodsThis systematic literature review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement and registered on PROSPERO (CRD42021230416). Studies on AS for LRMs with at least 3 years' follow-up were eligible. Two review authors independently screened the literature, extracted data, and assessed risk of bias. The primary outcomes were metastasis rate, renal cell carcinoma (RCC)-specific mortality (RCC-SM) and all-cause mortality (ACM). Pooled estimates were obtained from random-effects models. Subgroup analyses were performed for small renal masses (SRMs; ≤4 cm) and non-SRMs (>4 cm). ResultsWe analysed 18 unique cohorts comprising 2066 patients. The pooled initial maximum tumour size was 2.8 cm (95% confidence interval [CI] 2.7-3.0) and the percutaneous biopsy rate was 28%. The pooled mean annual growth rate was 2.8 mm (95% CI 2.1-3.4). Within a pooled mean follow-up of 53 months, 2.1% (95% CI 1.0-3.6) of patients developed metastatic disease, 1.0% (95% CI 0.3-2.1) died from RCC and 22.6% (95% CI 15.8-30.2) died from any cause. For patients with SRMs (nine studies, n = 987), the pooled metastasis rate was 1.8% (95% CI 0.5-3.7), RCC-SM was 0.6% (95% CI 0-2.1), and ACM was 28.5% (95% CI 17.4-41.4). Across five studies reporting on outcomes of 239 patients with non-SRMs, the pooled metastasis rate was 5.1% (95% CI 0-17.3), RCC-SM was 2.1% (95% CI 0-8.9) and ACM was 29.1% (95% CI 13.6-47.3). This review is limited by non-standardized inclusion criteria, definitions and follow-up, data heterogeneity, limited patient numbers in sub-analyses and absence of high-quality studies. ConclusionsActive surveillance is a safe intermediate-and long-term management option for well-selected patients with LRMs, especially those with SRMs. Limited data are available for non-SRMs, but current evidence would support further evaluation of this approach in selected patients. It is not possible to draw definitive conclusions until more high-quality data become available.

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“…TA techniques were developed to improve patient procedural tolerance and reduce the potential complications of PN [4]. As robot-assisted partial nephrectomy (RAPN) has become the preferred nephron-sparing surgical procedure in most centers [5], it is being offered in these cases, given its low morbidity [6,7] and potential oncological benefit in the long term [8,9].…”

Section: Introductionmentioning

confidence: 99%

Robotic-assisted Partial Nephrectomy for “Very Small” (<2 cm) Renal Mass: Results of a Multicenter Contemporary Cohort

Carbonara

Simone

Minervini

et al. 2021

European Urology Focus

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Conditional survival of patients with small renal masses undergoing active surveillance

Abstract: The conditional survival probability of patients with SRMs <3 cm on AS increased after 2 years. This information may prove useful to urologists and patients who are considering continuing AS vs intervention after the first 2 years on AS.

Cited by 16 publications

References 29 publications

Surveillance for low-risk kidney cancer: a narrative review of contemporary worldwide practices

Surveillance for low-risk kidney cancer: a narrative review of contemporary worldwide practices

Intermediate‐ and long‐term oncological outcomes of active surveillance for localized renal masses: a systematic review and quantitative analysis

Robotic-assisted Partial Nephrectomy for “Very Small” (<2 cm) Renal Mass: Results of a Multicenter Contemporary Cohort

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