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Renal tumor natural history: the rationale and role for active surveillance
Michael A S Jewett1, Alvaro Zuniga
1Division of Urology, Department of Surgical Oncology, Princess Margaret Hospital and the University Health Network, University of Toronto, 610 University Avenue, 3-124, Toronto, Ontario, Canada M5G 2C4. m.jewett@utoronto.ca
Abstract:
Renal cell carcinoma (RCC) is the most common malignancy of the kidney. Despite widespread treatment at diagnosis, overall mortality rates associated with RCC have not decreased. Partly because of the more frequent use of abdominal imaging, diagnosis as an incidental finding has increased. The largest increase in incidence is in tumors smaller than 4 cm, termed small renal masses (SRMs). SRMs that are RCC may frequently be growth slowly and have a low risk of early progression. Initial active surveillance with delayed treatment for progression for selected patients should be considered. This should result in an overall decrease in treatment burden and cost saving.
Insights
Active surveillance for small renal masses (SRMs) may be a viable option for selected patients with renal cell carcinoma (RCC). This approach could reduce treatment burden and healthcare costs.
Area of Science:
- Urology
- Nephrology
- Oncology
Background:
- Renal cell carcinoma (RCC) is the most common kidney cancer.
- Despite advancements in treatment, RCC mortality rates remain high.
- Increased abdominal imaging leads to more incidental diagnoses of small renal masses (SRMs).
Purpose of the Study:
- To evaluate the potential benefits of active surveillance for SRMs.
- To determine if delayed treatment for selected patients can decrease overall treatment burden and costs.
Main Methods:
- Review of current literature on small renal masses and renal cell carcinoma.
- Analysis of tumor growth patterns and progression risk for SRMs.
- Assessment of treatment outcomes and cost-effectiveness of active surveillance versus immediate intervention.
Main Results:
- Small renal masses (SRMs) that are renal cell carcinoma (RCC) often exhibit slow growth.
- Many SRMs have a low risk of early progression.
- Active surveillance may be suitable for selected patients, potentially reducing overtreatment.
Conclusions:
- Active surveillance for selected patients with small renal masses (SRMs) is a potential strategy.
- This approach may lead to a reduced treatment burden and significant cost savings in managing renal cell carcinoma (RCC).
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