1647 CHARACTERISTICS AND SHORT-TERM OUTCOMES OF SMALL RENAL MASSES CHOSEN FOR ACTIVE SURVEILLANCE THROUGH A MULTIDISCIPLINARY SMALL KIDNEY TUMOR CONFERENCE

Abstract

You have accessJournal of UrologyKidney Cancer: Localized (IV)1 Apr 20131647 CHARACTERISTICS AND SHORT-TERM OUTCOMES OF SMALL RENAL MASSES CHOSEN FOR ACTIVE SURVEILLANCE THROUGH A MULTIDISCIPLINARY SMALL KIDNEY TUMOR CONFERENCE Michael Rydberg, Ornob Roy, Kris Gaston, Chris Teigland, and Stephen Riggs Michael RydbergMichael Rydberg Charlotte, NC More articles by this author , Ornob RoyOrnob Roy Charlotte, NC More articles by this author , Kris GastonKris Gaston Charlotte, NC More articles by this author , Chris TeiglandChris Teigland Charlotte, NC More articles by this author , and Stephen RiggsStephen Riggs Charlotte, NC More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.3113AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES In 2004, we created and heavily resourced a multidisciplinary Small Kidney Tumor Conference to effectively manage the increasing number of small renal masses (SRM's, <4cm) presenting to our institution. Active surveillance (AS) has been a common recommendation for patients with small masses and multiple comorbidities, but questions of safety, feasibility, and practical implementation remain. This study aims to examine the outcomes of the population pursuing AS as recommended by our conference. METHODS All patients presented to our Small Kidney Tumor Conference from 2005 to 2010 and recommended to begin AS of their masses were identified from conference databases. Patient and tumor characteristics (diameter and RENAL characteristics - exophytic vs. endophytic nature and nearness to collecting system) were assessed at study entry and each subsequent study; treatment outcomes were analyzed for those patients progressing to treatment. RESULTS Sixty patients with 71 masses were recommended to begin active surveillance of their lesions. The median age at study entry was 64 years, with a mean age-adjusted Charlson Comorbidity Index score of 3.7. The mean initial tumor size was 1.8 cm, with 92% of masses under 3 cm. Eighteen patients (30%) were noncompliant or lost to follow-up, with 12 lost immediately after the first conference. In the population with at least 1 follow-up study, the median number of imaging studies was 3, with a median 6 month interval between the 1st and 2nd and 2nd and 3rd studies. Twenty-seven patients (45%) received some form of treatment. The mean tumor growth rate was 0.29 cm/year, with the growth rate of those receiving treatment (0.46 cm/year) significantly greater than those not receiving treatment (0.07 cm/year) (p=.0013). Two patients (3%) developed metastatic disease and died from renal cell carcinoma after being placed on active surveillance; these patients presented with significantly larger tumors (4.2 vs 1.8 cm; p=.0012) and more rapid growth rates (1.64 vs. 0.29 cm/yr; p<.001) than average. CONCLUSIONS Our series suggests that AS for SRM's has acceptable short-term outcomes; however, compliance - even in the most favorable of situations - may be an issue as 30% of our patients were lost to follow-up. Furthermore, those patients with larger tumors in our series had the worst outcomes. These factors demonstrate the paramount importance of appropriately selecting candidates for AS. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e677 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Michael Rydberg Charlotte, NC More articles by this author Ornob Roy Charlotte, NC More articles by this author Kris Gaston Charlotte, NC More articles by this author Chris Teigland Charlotte, NC More articles by this author Stephen Riggs Charlotte, NC More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...