1072 OUTCOMES AND TUMOR GROWTH RATE OF RENAL MASSES ARE DEPENDENT ON SIZE AT PRESENTATION IN A WATCHFUL WAITING COHORT

Abstract

You have accessJournal of UrologyKidney Cancer: Localized1 Apr 20111072 OUTCOMES AND TUMOR GROWTH RATE OF RENAL MASSES ARE DEPENDENT ON SIZE AT PRESENTATION IN A WATCHFUL WAITING COHORT Naji Touma, Patrick McGarry, Jun Kawakami, Richard Sowery, Michael Leveridge, and Robert Siemens Naji ToumaNaji Touma Kingston, Canada More articles by this author , Patrick McGarryPatrick McGarry Kingston, Canada More articles by this author , Jun KawakamiJun Kawakami Calgary, Canada More articles by this author , Richard SoweryRichard Sowery Kingston, Canada More articles by this author , Michael LeveridgeMichael Leveridge Kingston, Canada More articles by this author , and Robert SiemensRobert Siemens Kingston, Canada More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1110AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Conservative management of small renal masses (SRM) is an emerging concept and has been advocated as an alternative form of management to extirpative and ablative techniques. The natural history of SRM and the role of watchful waiting is currently an active area of research with an important focus on indicators of progression. Herein we report our long-term results of a prospectively followed cohort of patients managed on a watchful waiting protocol. METHODS A previously reported watchful waiting protocol at Queen's University was established for patients with any renal mass <7 cm. Patients enrolled were highly selected: either too infirm to undergo surgery or declined any intervention/clinical trial involvement. The program was established in November 1997 and 53 patients have enrolled up to May 2009. Parameters reported here include tumor growth rate, metastases-free and overall survival dichotomized by mass size at presentation. RESULTS Median age of the cohort was 75 years old and median follow-up was 40.2 months. At the time of initial presentation, 11 and 42 patients had renal masses > 4 cm or < 4 cm (SRM) respectively with a median size of 3.0 cm for the entire cohort. The growth rate of masses > 4 cm was 1.06 cm per year [95% confidence interval: 0.89 to 1.22 cm] versus 0.288 cm per year [95% confidence interval: 0.257 to 0.367 cm] for SRM (< 4cm). Metastasis free survival was 81.8% (9/11) and 97.6% (41/42) in the > 4cm and < 4cm cohort respectively (OR: 9.1, p=0.11). Overall survival in patients with masses > 4 cm was 54.5% versus 83.3% in those with SRM (< 4 cm) (OR: 4.2, p=0.06) underscoring the selectivity of this cohort, especially those with larger masses. CONCLUSIONS This longitudinal cohort study demonstrates tumor growth rates consistent with other reports on SRM (< 4cm); however, there is significant differences in growth rate depending on size at presentation, particularly if greater than 4 cm. Ongoing prospective investigations to validate predictive tools for progression are critical. Conservative management of renal masses should be reserved for highly selected patients with limited life expectancy, particularly those masses larger than 4 cm. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e431 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Naji Touma Kingston, Canada More articles by this author Patrick McGarry Kingston, Canada More articles by this author Jun Kawakami Calgary, Canada More articles by this author Richard Sowery Kingston, Canada More articles by this author Michael Leveridge Kingston, Canada More articles by this author Robert Siemens Kingston, Canada More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...