Small Renal Masses: Incidental Diagnosis, Clinical Symptoms, and Prognostic Factors

Introduction. The small renal masses (SRMs) have increased over the past two decades due to more liberal use of imaging techniques. SRMs have allowed discussions regarding their prognostic, diagnosis, and therapeutic approach.Materials and methods.Clinical presentation, incidental diagnosis, and prognosis factors of SRMs are discussed in this review.Results.SRMs are defined as lesions less than 4 cm in diameter. SRM could be benign, and most malignant SMRs are low stage and low grade. Clinical symptoms like hematuria are very rare, being diagnosed by chance (incidental) in most cases. Size, stage, and grade are still the most consistent prognosis factors in (RCC). An enhanced contrast SRM that grows during active surveillance is clearly malignant, and its aggressive potential increases in those greater than 3 cm. Clear cell carcinoma is the most frequent cellular type of malign SRM.Conclusions.Only some SRMs are benign. The great majority of malign SRMs have good prognosis (low stage and grade, no metastasis) with open or laparoscopic surgical treatment (nephron sparing techniques). Active surveillance is an accepted attitude in selected cases.

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Does treatment approach for small renal masses affect survival in patients 70 years old?

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.6_suppl.658 ◽

2018 ◽

Vol 36 (6_suppl) ◽

pp. 658-658

Author(s):

Lukas Hockman ◽

Tyler Haden ◽

Alex Henderson ◽

Naveen Pokala

Keyword(s):

Overall Survival ◽

Tumor Size ◽

Cox Regression ◽

Imaging Techniques ◽

Low Grade ◽

Small Renal Masses ◽

Cancer Specific Survival ◽

Renal Masses ◽

Significant Difference ◽

The Mean

658 Background: With the advent of modern imaging techniques small renal masses are being diagnosed more frequently. Many of these masses are benign, and those that are malignant are often low grade and rarely affect the survival. Surveillance is more commonly being advocated as an option for these masses. This study elucidates survival following different treatment approaches. Methods: SEER 18 data from 2004-13 identified 10,477 patients 70 years and older with renal cell carcinoma and tumors greater than or equal to 3 cm. Exclusion criteria included multiple primaries, distant metastasis and node positive disease. Data was collected on demographics, treatment patterns, overall survival and cancer specific survival. Kaplan-Meier analysis and Cox regression models were used to compare outcomes. Results: After exclusion 5084 patients remained. The mean age was 76.4 years. The mean tumor size was 2.3cm. Tumor laterality was right in 2610, left in 2467, bilateral in 2 and unspecified in 5. Racial analysis identified 84% of patients as white, 9% as black and 7% as other. Gender split was 51% male. Treatment methods included 791 ablations and 3324 surgical resections (radical or partial nephrectomy). The remaining 969 patients did not have treatment (surveillance). Survival was measured at 60 and 118 months. The overall survival was 75% and 54% respectively for ALL patients, 82% and 62% for ablation, 42% and 19% for surveillance and 82% and 62% for resection. Cancer specific survival was 97% and 96% for ablation, 83% and 74% for surveillance and 96% and 94% for resection. Surgical resection or ablation significantly improved survival at 5 and 10 years (p = < 0.0001). Multivariate analysis showed survival was affected by age and year of diagnosis, but not by tumor size. Conclusions: The significant difference in overall survival suggests appropriate selection of patients for surveillance based on medical comorbidities. Treatment with curative intent improves survival in patients with greater than or equal to 3 cm renal masses, even in patients 70 years and older, and must be offered to patients without significant comorbidities.

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Treatment on active surveillance of small renal masses: Progression vs. preference

Canadian Urological Association Journal ◽

10.5489/cuaj.7451 ◽

2021 ◽

Vol 16 (4) ◽

Author(s):

Douglas Cheung ◽

Jed Frankel ◽

Pavinder Tut ◽

Maria Komisarenko ◽

Lisa Martin ◽

...

Keyword(s):

Active Surveillance ◽

Care Center ◽

Tertiary Care ◽

Qualitative Assessment ◽

Low Grade ◽

Metastatic Progression ◽

Clinical Progression ◽

Small Renal Masses ◽

Renal Masses ◽

Patient Counselling

Introduction: Active surveillance (AS) of small renal masses (SRM) is increasingly recognized as a safe option. A recent U.S. study found that half of patients receiving treatment on AS were for preference, but these findings may not be generalizable to other jurisdictions and healthcare models. We aimed to investigate AS failure rates and causes among a contemporary biopsy-evaluated cohort in Canada. Methods: A retrospective review was performed of SRM patients on AS undergoing treatment at our tertiary care center (1999–2018). All patients had undergone renal biopsy and been diagnosed with renal cell carcinoma (RCC). Demographic and clinical parameters surrounding the decision to treat were extracted from chart review. Indications for treatment were dichotomized into clinical (radiographical) progression or preference. Qualitative assessment of clinic notes confirmed treatment indication. Ethics approval was obtained. Results: A total of 38 SRM-RCC patients who underwent treatment on AS were identified, of which 29 had been on AS ≥1 year. Most (75.9%) were male, and the mean age beginning AS was 65.9±9.0 years. Most patients had clear-cell RCC with low-grade disease. Seventeen of 29 (58.6%) patients experienced clinical progression after 3.82 (2.57–7.16) years, whereas preference accounted for 12/29 (41.4%) after 2.22 (1.69–3.53) years (time-to-treatment p=0.032). The longest duration on AS was 14.2 years prior to clinical progression. No patients had metastatic progression before treatment. Conclusions: Two-fifths of patients received treatment for preference and at a much higher rate vs. clinical progression. These findings suggest a clinical gap where effective patient counselling, prior to and during AS, may improve adherence.

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Triggers for delayed intervention in patients with small renal masses undergoing active surveillance: a systematic review

Minerva Urologica e Nefrologica ◽

10.23736/s0393-2249.20.03870-9 ◽

2020 ◽

Vol 72 (4) ◽

Cited By ~ 1

Author(s):

Riccardo Campi ◽

Francesco Sessa ◽

Francesco Corti ◽

Diego M. Carrion ◽

Andrea Mari ◽

...

Keyword(s):

Systematic Review ◽

Active Surveillance ◽

Small Renal Masses ◽

Renal Masses ◽

Delayed Intervention

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Faculty Opinions recommendation of Active surveillance of small renal masses offers short-term oncological efficacy equivalent to radical and partial nephrectomy.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.717948514.793453573 ◽

2012 ◽

Author(s):

Robert Huddart

Keyword(s):

Partial Nephrectomy ◽

Active Surveillance ◽

Short Term ◽

Small Renal Masses ◽

Renal Masses

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Clinical and radiological findings for small renal masses under active surveillance

Urologic Oncology Seminars and Original Investigations ◽

10.1016/j.urolonc.2021.04.010 ◽

2021 ◽

Author(s):

Tarek Ajami ◽

Carmen Sebastia ◽

Daniel Corominas ◽

Maria Jose Ribal ◽

Carlos Nicolau ◽

...

Keyword(s):

Active Surveillance ◽

Radiological Findings ◽

Small Renal Masses ◽

Renal Masses

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Active Surveillance of Small Renal Masses: A Systematic Review

Kidney Cancer ◽

10.3233/kca-210114 ◽

2021 ◽

pp. 1-14

Author(s):

Elizabeth E. Ellis ◽

Edward Messing

Keyword(s):

Active Surveillance ◽

Meta Analysis ◽

Cost Effective ◽

Management Approach ◽

Small Renal Masses ◽

Cancer Specific Survival ◽

Renal Masses ◽

Review Current ◽

Delayed Intervention

Background: Our goal is to review current literature regarding active surveillance (AS) of small renal masses (SRMs) and identify trends in survival outcomes, factors that predict the need for further intervention, and quality of life (QOL). Methods: We performed a comprehensive literature search in PubMed and EMBASE and identified 194 articles. A narrative summary was performed in lieu of a meta-analysis due to the heterogeneity of selected studies. Results: Seventeen articles were chosen to be featured in this review. Growth rate (GR) was not an accurate predictor of malignancy, although it was the characteristic most commonly used to trigger delayed intervention (DI). The mean 5-year overall survival (OS) of all studies was 73.6% ±1.7% for AS groups. The combined cancer specific survival (CSS) for AS is 97.1% ±0.6% , compared to 98.6% ±0.4% for the primary intervention (PI) groups, (p = 0.038). Conclusions: Short and intermediate-term data demonstrate that AS with the option for DI is a management approach whose efficacy (in terms of CSS) approaches that of PI at 5 years, is cost effective, and prevents overtreatment, especially in patients with significant comorbidities.

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Determinants of Active Surveillance in Patients With Small Renal Masses

Urology ◽

10.1016/j.urology.2018.07.021 ◽

2019 ◽

Vol 123 ◽

pp. 167-173 ◽

Cited By ~ 8

Author(s):

Kevin A. Nguyen ◽

Adam C. Nolte ◽

Oriyomi Alimi ◽

Walter Hsiang ◽

Amanda J. Lu ◽

...

Keyword(s):

Active Surveillance ◽

Small Renal Masses ◽

Renal Masses

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Changing the Stage, Grade and Histological Subtypes of Renal Cell Carcinomas during 10 Years Period

Prague Medical Report ◽

10.14712/23362936.2017.13 ◽

2017 ◽

Vol 118 (4) ◽

pp. 119-127

Author(s):

Selahattin Çalışkan ◽

Orhan Koca ◽

Mehmet Akyüz ◽

Metin İshak Öztürk ◽

Muhammet Ihsan Karaman

Keyword(s):

Renal Cell ◽

Imaging Techniques ◽

Transitional Cell ◽

Renal Cell Carcinomas ◽

Small Renal Masses ◽

Renal Masses ◽

Renal Tumours ◽

Group 2 ◽

Group 1

Renal cell carcinomas (RCCs) account 80–85% of all primary renal neoplasms and originate from the renal cortex. The patients who underwent radical or partial nephrectomy for renal tumour in our unit between January 2005 and 2015 were evaluated retrospectively. The patients were divided into two groups; group 1 includes patients who were treated between January 2005 and December 2009, group 2 those from January 2010 to 2015. There were 103 patients in group 1. The patients were between 21 and 89 years with mean age of 61.46 year. Renal cell carcinomas account 83.4% of the patients, benign renal tumours were 8.7% and transitional cell carcinomas were 7.7% of the patients in group 1. A total of 32.5% RCCs were classified as pT1a, 24.4% as pT1b, 15.1% as pT2a, 11.6% as pT2b, 15.1% as pT3a and 1.1% as pT4. There were 202 patients in group 2 and the patients were between 27 and 81 years with mean age of 58.5 year. Renal cell carcinomas comprised the main bulk of the tumours with 182 nephrectomy specimens. According to the pathological classification of RCCs, 51 specimens were found as pT1a, 54 were pT1b, 13 were pT2a, 14 were pT2b, 48 were pT3a and 2 were pT4. Although, the incidence of small renal masses has been increasing with widespread use of imaging techniques and recent advancements, the proportion of high grade and advanced stage renal tumours increased during the study period.

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