Active surveillance of renal masses in elderly patients

We identify and report on a large number of patients treated with active surveillance for incidentally diagnosed renal masses at our institution.

We identified all patients 75 years or older evaluated in our department for a renal mass between January 2000 and December 2006. A total of 110 patients with enhancing renal masses were initially treated with active surveillance and this group made up the cohort for our study. Medical records were reviewed for clinical and radiological followup, and vital status was obtained from the Social Security Death Index. Clinical and radiographic followup was available for review on 104 and 89 patients, respectively.

Patients had a median age of 81 years (range 76 to 95) with a median Charlson comorbidity index of 2 (range 0 to 7) at diagnosis. Patients had as many as 9 tumors being followed (median of 1) with a median tumor size of 2.5 cm (range 0.9 to 11.2). During a median followup of 24 months (range 1 to 90) mean tumor growth rate was 0.26 cm per year. Of the 89 patients with radiological followup 38 (43%) exhibited no tumor growth on active surveillance. Comparison of the clinical and radiographic features of patients with tumor growth and those with stable disease revealed no statistical differences. Four patients (3.6%) were treated as a result of disease progression 12 to 54 months after diagnosis. At the conclusion of the study 34 patients (31%) were deceased. To our knowledge the renal mass did not contribute to the cause of death in any patient.

Active surveillance of incidental renal masses appears to be a viable option for older patients with multiple medical comorbidities and a limited life expectancy.