Predictors of growth kinetics and outcomes in small renal masses (SRM ≤4cm in size): Tayside active surveillance cohort (TASC) study.
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PATERSON, C., YEW-FUNG, C., SWEENEY, C., SZEWCZYK-BIEDA, M., LANG, S. and NABI, G. 2017. Predictors of growth kinetics and outcomes in small renal masses (SRM ≤4cmin size): Tayside active surveillance cohort (TASC) study. European journal of surgical oncology [online], 43(8), pages 1589-1597. Available from: https://doi.org/10.1016/j.ejso.2017.03.006
Objective: To determine outcomes of small renal masses (≤4 cm) on active surveillance and explore factors which can influence their growth. Patients and methods: Two hundred twenty six patients between January 2007 and December 2014 were analysed 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. Results: 101 (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 seven 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. Conclusions: A 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.