Predicting Oncologic Outcomes in Small Renal Tumors

Kapur, Payal; Zhong, Hua; Araj, Ellen; Christie, Alana; Cai, Qi; Kim, David; Miyata, Jeffrey; Tcheuyap, Vanina Toffessi; Brandenburg, Olivia; Carrillo, Deyssy; Pedrosa, Iván; Brugarolas, James; Cadeddu, Jeffrey A.

doi:10.1016/j.euo.2022.08.003

Cited by 8 publications

(4 citation statements)

References 36 publications

(47 reference statements)

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“…In a similar study of the same patient cohort with a focus on cT1a RCC, the disease recurrence rate after treatment was found to be 7.5% (16). In a large cohort of 1,539 patients with surgically treated small renal masses with a median follow-up period of 3 years, 2.4% of patients developed metastases (17). In our cohort of immunosuppressed patients with cT1 RCC over median follow-up periods of 4.5, 3.4, and 3.9 years for patients who had surgery, ablation, and active surveillance, respectively, only three out of 74 (4%) patients developed local recurrence after treatment, including two out of 74 (3%) patients who developed metastatic disease.…”

Section: Discussionmentioning

confidence: 83%

Management of stage 1 renal cell cancer in patients immunosuppressed for organ transplantation or autoimmune disease

Ghasemzadeh,

Wendt,

Dolan

et al. 2023

Front. Urol.

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ObjectiveTo describe the treatment and outcomes of patients who are medically immunosuppressed due to prior organ transplantation or autoimmune disease with clinical T1 renal cell carcinoma (cT1).MethodsAn institutional database of patients treated for RCC was queried for patients with cT1 RCC and on chronic medical immunosuppression at the time of RCC diagnosis. The outcomes for patients undergoing (1) surgery, (2) ablation, or 3) active surveillance (AS) are described.ResultsBetween 2010 and 2022, 74 medically immunosuppressed patients with RCC were identified and treated using surgery (n = 29), ablation (n = 33), or AS (n = 12). Seven (58%) AS patients underwent deferred treatment (six ablations and one nephrectomy) due to tumor growth. For surgery patients and ablation patients, the 30-day readmission rates [17% and 9%, respectively (p = 0.7)], and 90-day complication rates [24% and 21%, respectively (p = 0.9)] were similar. One (3%) surgical patient and two (6%) ablation patients recurred locally. Despite being immunosuppressed, only one (3%) surgical patient, one (3%) ablation patient, and no AS patients progressed to metastatic disease. No significant differences were noted for the local recurrence-free rates, metastasis-free rates, and overall survival for the three cohorts (p > 0.05 for all).ConclusionsPatients with stage one RCC with medical immunosuppression can be safely managed through surgery, thermal ablation, or active surveillance, with similar outcomes to historical series of non-immunosuppressed patients. Future prospective studies should investigate shared decision making in this patient cohort and include discussion of less aggressive options that minimize morbidity but preserve oncologic control.

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Section: Discussionmentioning

confidence: 83%

Management of stage 1 renal cell cancer in patients immunosuppressed for organ transplantation or autoimmune disease

Ghasemzadeh,

Wendt,

Dolan

et al. 2023

Front. Urol.

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“…Tumor size at initial detection was an important criterion, but diverse patterns were observed, especially in relation to patients' age. Size is critical as it is directly associated with the probability of metastatic disease [18,19]. In addition to the initial tumor size, the annual growth rate and growth beyond a preset diameter were frequently considered together.…”

Section: Discussionmentioning

confidence: 99%

Contemporary Management of Small Renal Masses by Urologic Oncologists: A 2022 Korean Renal Cancer Study Group Practice Pattern Survey

Choi

Song

Suh

et al. 2023

Korean J Urol Oncol

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Purpose: Increased abdominal imaging brought about an explosive increase in the incidental detection of small renal masses (SRMs). In the absence of optimal guidelines for health screening, as well as subsequent diagnostic and therapeutic action plans, incidentally detected SRMs may likewise increasingly become a dilemma, especially in an aging society. In the current study, we aimed to describe the current practice patterns for incidentally detected SRMs among urologic oncologists and to identify key indicators in action plans for active surveillance.Materials and Methods: A survey containing 18 questions on SRM management patterns was designed. In June 2022, an online survey was sent to all 711 active members of the Korean Urological Oncology Society via email. After response collection, a consensus meeting of the Korean Renal Cancer Study Group, which 19 specialists attended, was held to analyze the results.Results: In total, 176 responses from participants practicing in an academic setting were obtained (24.8%, 176 of 711). Regarding the age of patients with SRMs, 42.6% (n=72) responded that they would recommend diagnostic evaluation and definitive treatment for anyone under 80 years of age as long as the patient was healthy. The most commonly used target indicators for surveillance termination were a tumor growth rate above a certain velocity (57.9%, n=102) and size increase above a certain diameter (36.9%, n=65). Renal mass biopsy was recommended in very select cases (<10% of all patients) by most respondents (53.4%, n=94), followed by “not using it at all” in 25.6% (n=45).Conclusions: We described the current practice patterns for incidentally detected SRMs among urologic oncologists and identified key indicators in action plans for active surveillance. This survey provided robust information, empowering physicians with a detailed knowledge of practice patterns and valuable insights on SRMs.

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“…In a recent study of 1984 patients with SRMs, BRCA1- associated protein-1 ( BAP1 ) loss was evaluated. This loss-of-function mutation is found in 15% of ccRCC lesions and is associated with worse survival outcomes [ 9 ]. BAP1 status was found to be independently associated with time to metastasis for ccRCC (hazard ratio [HR]: 3.05; 95% CI: 1.30 to 7.15; p < 0.02).…”

mentioning

confidence: 99%

“…BAP1 status was found to be independently associated with time to metastasis for ccRCC (hazard ratio [HR]: 3.05; 95% CI: 1.30 to 7.15; p < 0.02). This association remained significant after adjusting for TNM (tumor-node-metastasis) stage and SSIGN (stage, size, grade, and necrosis) score in the multivariable analysis (HR: 3.58; 95% CI: 1.53 to 8.35; p < 0.003) [ 9 ].…”

mentioning

confidence: 99%