Natural History of Renal Cortical Neoplasms During Active Surveillance With Follow-up Longer Than 5 Years

Haramis, G. M.; Mues, Adam C.; Rosales, Juan Carlos; Okhunov, Zhamshid; Lanzac, Alberto Perez; Badani, Ketan K.; Gupta, Mantu; Benson, Mitchell C.; McKiernan, James M.; Landman, Jaime

doi:10.1016/j.urology.2010.09.031

Cited by 52 publications

(45 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Of these contributions, just four reported a mean follow up longer than 3 years, and, remarkably, just two studies had an observation time higher than 5 years. 15,16,20,37 Among all reports, the mean linear growth rate was low, ranging from 0.1 to 0.4 cm/year, and only a few patients experienced progression to metastases (0-5.7%). Deaths from renal cancer-related causes were uncommon (Table 1), thereby highlighting the safety and feasibility of AS for SRM in selected patients.…”

Section: Evidence Analysis As For Renal Tumors ≤4 CM (Srm)mentioning

confidence: 98%

“…[38][39][40] In a comprehensive meta-analysis of 10 studies from nine single-institutional series, Chawla et al reported outcomes of 234 expectantly managed SRM. 11 The evaluated series included six to 40 patients, with a mean follow up of 34 months (median 32, range [26][27][28][29][30][31][32][33][34][35][36][37][38][39]. In all series combined together, the mean tumor size at presentation was 2.6 cm (median 2.48 cm), and the mean linear growth rate was 0.28 cm/year.…”

Section: Evidence Analysis As For Renal Tumors ≤4 CM (Srm)mentioning

confidence: 99%

See 1 more Smart Citation

Active surveillance for clinically localized renal tumors: An updated review of current indications and clinical outcomes

et al. 2015

View full text Add to dashboard Cite

The widespread use of abdominal imaging has led to an increasing detection of small renal masses, and approximately 20-30% of those tumors will prove to be benign, with low metastatic potential if not immediately treated. In elderly or comorbid patients diagnosed with small renal masses, competing cause mortality seems to exceed cancer-specific mortality at short-and intermediate-term follow up. In these cases, surgery might represent an overtreatment, and an expectant management, such as active surveillance, might be proposed. According to the current available evidence, active surveillance is a safe and reasonable option for patients with renal tumors 4 cm (cT1a) and short life expectancy. A few studies with short-term follow up reported the preliminary results of active surveillance even in cT1b-cT2 tumors, with acceptable risk of disease progression and mortality, even if this approach should be considered in this setting only for highly-selected and wellinformed patients. Furthermore, surveillance protocols can be proposed in selected patients with uncomplicated benign tumors, such as angiomyolipomas, in which active surveillance should be considered the initial standard management. At present, reliable clinical predictors of a tumor's growth rate and aggressiveness are not available. Renal tumor biopsy is useful in the clinical work-up of patients who are candidates for active surveillance, in order to improve patient selection based on tumor histological characterization. Despite the proof of safety offered by expectant management for small renal masses in selected patients, further prospective studies with longer follow up are required in order to confirm the indications and long-term oncological outcomes of active surveillance protocols for renal tumors.

show abstract

Section: Evidence Analysis As For Renal Tumors ≤4 CM (Srm)mentioning

confidence: 98%

Section: Evidence Analysis As For Renal Tumors ≤4 CM (Srm)mentioning

confidence: 99%

Active surveillance for clinically localized renal tumors: An updated review of current indications and clinical outcomes

et al. 2015

View full text Add to dashboard Cite

show abstract

“…Canadian phase II trials reported, among 178 patients, only one patient who died from metastasis of renal cell carcinoma, and 10 patients who died from unrelated causes at 3-42 months [21]. In previous small retrospective studies, the possibility of metastasis during AS for SRMs has been reported as 0%-5% [1][2][3][4]9]. The Delayed Intervention and Surveillance for Small Renal Masses Registry, the largest prospective study, did not show distant metastasis in 223 patients after 5 years of follow-up [13].…”

Section: Discuissionmentioning

confidence: 99%

“…However, active surveillance (AS) for SRM is still demanded for clinical safety in addition to these rationales. Several oncological outcomes and safety have been reported in AS cohort for SRMs [1,4,9,13]. The Delayed Intervention and Surveillance for Small Renal Masses Registry, the largest prospective AS cohort for SRMs, reported that the 5-year overall survival and cancer-specific survival were 75% and 100%, respectively [13].…”

Section: Introductionmentioning

confidence: 99%

“…The Delayed Intervention and Surveillance for Small Renal Masses Registry, the largest prospective AS cohort for SRMs, reported that the 5-year overall survival and cancer-specific survival were 75% and 100%, respectively [13]. Although a few studies have reported early metastasis, most have demonstrated the stability of AS [4,9]. Furthermore, Shuch et al [14] reported that patients with radical or partial nephrectomy may have more frequent secondary cancers, cardiovascular events, and deterioration of renal function than those who did not have that surgery.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation