Active surveillance for renal cortical neoplasms

Area of Science:

• Urology
• Oncology
• Nephrology

Background:

• Renal cortical neoplasms are common, particularly in older adults.
• Active surveillance (AS) is an increasingly utilized management strategy for these tumors.
• Patient selection and monitoring protocols for AS are critical for successful outcomes.

Purpose of the Study:

• To evaluate the single-center experience with active surveillance for renal cortical neoplasms.
• To assess the safety and efficacy of active surveillance in older patients with comorbidities.
• To identify factors associated with AS failure in patients with renal cortical neoplasms.

Main Methods:

• Retrospective analysis of a urological oncology database (January 1993 - January 2009).
• Inclusion of 212 patients with 223 renal cortical neoplasms managed initially by active surveillance.
• Comparison of patient and tumor characteristics between successful AS and failed AS cases.

Main Results:

• Median patient age was 71 years; median Charlson comorbidity index was 3.
• Median tumor size increased from 2.8 cm to 3.7 cm during surveillance.
• Active surveillance failed in 7% of patients (15/212), with 2% progressing to metastasis and 5% requiring intervention.

Conclusions:

• Active surveillance is a reasonable treatment option for select older patients with renal cortical neoplasms and comorbidities.
• The 3-year failure rate for active surveillance in this cohort was 7%.
• Initial tumor size and growth rate were significantly different between patients who continued AS and those who failed.