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Published on: March 30, 2015
Oncological Outcomes of Active Surveillance versus Surgery or Ablation for Patients with Small Renal Masses: A
Ichiro Tsuboi1, Pawel Rajwa2, Riccardo Campi3
1Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Shimane University Faculty of Medicine, Shimane, Japan; Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
Background And Objective:
While active surveillance (AS) is an alternative to surgical interventions in patients with small renal masses (SRMs), evidence regarding its oncological efficacy is still debated. We aimed to evaluate oncological outcomes for patients with SRMs who underwent AS in comparison to surgical interventions.
Methods:
In April 2024, PubMed, Scopus, and Web of Science were queried for comparative studies evaluating AS in patients with SRMs (PROSPERO: CRD42024530299). The primary outcomes were overall (OS) and cancer-specific survival (CSS). A random-effects model was used for quantitative analysis.
Key Findings And Limitations:
We identified eight eligible studies (three prospective, four retrospective, and one study based on Surveillance, Epidemiology and End Results [SEER] data) involving 4947 patients. Pooling of data with the SEER data set revealed significantly higher OS rates for patients receiving surgical interventions (hazard ratio [HR] 0.73; p = 0.007), especially partial nephrectomy (PN; HR 0.62; p < 0.001). However, in a sensitivity analysis excluding the SEER data set there was no significant difference in OS between AS and surgical interventions overall (HR 0.84; p = 0.3), but the PN subgroup had longer OS than the AS group (HR 0.6; p = 0.002). Only the study based on the SEER data set showed a significant difference in CSS. The main limitations include selection bias in retrospective studies, and classification of interventions in the SEER database study.
Conclusions And Clinical Implications:
Patients treated with AS had similar OS to those who underwent surgery or ablation, although caution is needed in interpreting the data owing to the potential for selection bias and variability in AS protocols. Our review reinforces the need for personalized shared decision-making to identify patients with SRMs who are most likely to benefit from AS.
Patient Summary:
For well-selected patients with a small kidney mass suspicious for cancer, active surveillance seems to be a safe alternative to surgery, with similar overall survival. However, the evidence is still limited and more studies are needed to help in identifying the best candidates for active surveillance.
Insights
Active surveillance (AS) for small renal masses (SRMs) shows similar overall survival to surgery. However, careful patient selection is crucial due to potential biases in current studies on AS for SRMs.
Area of Science:
- Urology
- Oncology
- Nephrology
Background:
- Small renal masses (SRMs) management often involves a choice between active surveillance (AS) and surgical intervention.
- The oncological efficacy of AS compared to surgery for SRMs remains a subject of ongoing debate and research.
Purpose of the Study:
- To evaluate and compare the oncological outcomes, specifically overall survival (OS) and cancer-specific survival (CSS), for patients with SRMs managed with AS versus surgical interventions.
- To synthesize evidence from existing comparative studies to inform clinical decision-making regarding SRMs treatment.
Main Methods:
- A systematic literature search was conducted in April 2024 across PubMed, Scopus, and Web of Science for comparative studies on AS versus surgical interventions in SRMs.
- The primary outcomes assessed were overall survival (OS) and cancer-specific survival (CSS).
- A random-effects model was employed for the quantitative synthesis of data from eight eligible studies involving 4947 patients.
Main Results:
- Pooling data including the SEER database indicated significantly higher OS rates for surgical interventions, particularly partial nephrectomy (PN).
- Excluding SEER data, no significant difference in OS was observed between AS and surgery overall, but PN showed longer OS than AS.
- Only the SEER data analysis revealed a significant difference in CSS; limitations include potential selection bias and data classification issues.
Conclusions:
- Active surveillance (AS) appears to be a safe alternative to surgery for well-selected patients with small renal masses (SRMs), demonstrating similar overall survival.
- Caution is advised when interpreting results due to potential selection bias and variations in AS protocols.
- Personalized, shared decision-making is essential to identify SRMs patients who would most benefit from AS, highlighting the need for further research.
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