Editorial Comment

Abstract

The choice of treatment for small renal masses remains a clinical challenge. One would expect that the utilization of less-invasive treatment options (initial observation and ablation) would be increasing, particularly among older and multimorbid patients diagnosed with an incidental small renal mass. The authors of this timely study evaluated the associations among patient and facility characteristics and the utilization of initial observation. 1 Maurice M.J. Zhu H. Kiechle J.E. et al. Nonclinical factors predict selection of initial observation for renal cell carcinoma. Urology. 2015; 86: 892-900 Abstract Full Text Full Text PDF Scopus (17) Google Scholar Less than 7% of patients included in the National Cancer Data Base were observed. A recent analysis of Surveillance, Epidemiology, and End Results data through 2009 also found that few (10%) patients were observed. 2 Huang W.C. Atoria C.L. Bjurlin M. et al. Management of small kidney cancers in the new millennium: contemporary trends and outcomes in a population-based cohort. JAMA Surg. 2015; 150: 664-672 Crossref PubMed Scopus (54) Google Scholar However, the large majority of patients with a renal mass do not undergo a diagnostic renal mass biopsy. 3 Leppert J.T. Hanley J. Wagner T.H. et al. Utilization of renal mass biopsy in patients with renal cell carcinoma. Urology. 2014; 83: 774-779 Abstract Full Text Full Text PDF PubMed Scopus (69) Google Scholar Patients on surveillance protocols will not have definitive pathology and as a result, may never be included in a cancer registry. 4 Meeks J.J. Gonzalez C.M. Standard of care for small renal masses in the 21st century. JAMA Surg. 2015; 150: 672-673 Crossref PubMed Scopus (2) Google Scholar The true utilization of surveillance for small renal masses remains unknown, and the epidemiology of kidney cancer using cancer registry data is biased to underestimate—perhaps significantly—the utilization of surveillance. Nonclinical Factors Predict Selection of Initial Observation for Renal Cell CarcinomaUrologyVol. 86Issue 5PreviewTo determine the rate of observation utilization over time and to identify factors influencing its use. Full-Text PDF ReplyUrologyVol. 86Issue 5PreviewWe appreciate the interest in our recent study entitled, “Nonclinical factors predict selection of initial observation for renal cell carcinoma.”1 Fundamentally, we agree with many of the points raised in the editorial comment; however, we would like to clarify some confusion regarding our study design, which may have led to a misinterpretation of our results.2 Full-Text PDF