Complex Renal Cysts (Bosniak ≥ IIF): Outcomes in a Population-Based Cohort Study.

Abstract

Simple SummaryResearchers from the University of Dundee have found that not all kidney cancers will need urgent surgery. In a published research in the Cancers, Dr Lucocq et al have carefully established database record of patients with kidney cancer looking like water filled sacs on CT scan and reported that these cancers are low grade and perhaps less harmful on long-term follow-up. In fact, behaviour of these cancer cells is much slower compared to other diseases such as heart failure and high blood pressure. Most people die from chronic disease much before cancer spread or progression. The researchers in this group have shown that surgical removal of these cancers, particularly in elderly people and those with other health conditions such as heart failure may not be necessary. Patients in Tayside Urological Cancers (TUCAN) database were carefully assessed using CT scans and discussed in multidisciplinary meetings and were followed up for more than 6 years. This kind of population-based study adds new knowledge to the understanding behaviour of a subset kidney cancers which otherwise have very poor outcome. The researchers and paper highlight careful documentation of cohort to understand natural history of disease.There is emerging evidence to suggest that con-current medical conditions influence the outcome of cancers, irrespective of therapy offered. The prevalence and impact of co-morbidities on the survival outcome of complex renal cystic masses in not known. The objective was to study complex renal cysts (Bosniak ) and assess the overall and renal cancer-specific survival in a population-based database including impact of con-current morbidities. The Tayside Urological Cancer Network (TUCAN) database covering a stable population of more than 416,090 inhabitants in a defined geographical area identified 452 complex renal cysts in 415 patients between 2009 and 2019. Each patient was tracked and followed up using a unique identifier and deterministic linkage methodology. The last date of follow-up including cause of death was determined. Co-morbidities were recorded from primary care referrals. Renal cancer-specific mortality was 1.7% at a median follow-up of 76.0 months; however, overall survival was poor, particularly in patients 70 years of age and with ≥ 2 significant co-morbid conditions (p < 0.0001). A total of 38.3% of the cohort showed con-current morbidities. Age and co-morbidities were significant risk factors for overall survival in patients with complex renal cystic disease and a careful assessment should be made to recommend surgical intervention in the elderly population, in particular in those with other health-related conditions.