Predictors of growth kinetics and outcomes in small renal masses (SRM ≤4cm in size): Tayside Active Surveillance Cohort (TASC) Study

Publication date: Available online 16 March 2017
Source:European Journal of Surgical Oncology (EJSO)
Author(s): Paterson Catherine, Chin Yew-Fung, Sweeney Clare, Szewczyk-Bieda Magda, Lang Stephen, Nabi Ghulam
ObjectiveTo determine outcomes of small renal masses (≤4cm) on active surveillance and explore factors which can influence their growth.Patients and Methods226 patients between January 2007 and December 2014 were analyzed using cross-linked methodology of healthcare data and independent review. Cancer specific and non-specific survival were the primary outcomes. Growth kinetics, factors influencing growth and need for interventions were secondary outcomes.Results101 (64.4%) solid and 4 (5.9%) cystic SRMs showed growth. 43 (19.02%) of SRMs required treatment interventions. Seven patients (7/158; 4.4%) died due to renal cancer at a median follow-up of 21.7 (SD 10.6, min 6-42) months, all in solid category. Independent review of serial radiological imaging of these 7 cases showed two patients had subtle metastatic disease at the initial presentation, and 5 of the 7 did not adhere to recommended imaging regime. 33 (33/158; 20.8%) died due to other causes including non-renal cancers (14/158; 8.8%). Multivariate analyses showed that lower eGFR at baseline, co-morbidities and tumour location were independently associated with growth in size.ConclusionsA higher cancer-specific mortality was seen in the present study compared to the reported literature. Independent critical review of imaging of cases with poor outcome underscored the importance of adherence to a robust protocol including follow up. Comorbid conditions had a significant impact on growth and overall survival of patients with SRMs.



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