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The natural history and predictors for intervention in patients with small renal mass undergoing active surveillance.

Bahouth Z, Halachmi S, Meyer G, Avitan O, Moskovitz B, Nativ O - Adv Urol (2015)

Bottom Line: Methods.The mean follow-up period was 34 months (12-112).None of the patients developed metastases.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Bnai Zion Medical Center, 3339414 Haifa, Israel ; Faculty of Medicine, Technion-Israel Institute of Technology, 3200003 Haifa, Israel.

ABSTRACT
Aim. To describe the natural history of small renal mass on active surveillance and identify parameters that could help in predicting the need for intervention in patients with small renal masses undergoing active surveillance. We also discuss the need for renal biopsy in the management of these patients. Methods. A retrospective analysis of 78 renal masses ≤4 cm diagnosed at our Urology Department at Bnai Zion Medical Center between September 2003 and March 2012. Results. Seventy patients with 78 small renal masses were analyzed. The mean age at diagnosis was 68 years (47-89). The mean follow-up period was 34 months (12-112). In 54 of 78 masses there was a growth of at least 2 mm between imaging on last available follow-up and diagnosis. Eight of the 54 (15%) masses which grew in size underwent a nephron-sparing surgery, of which two were oncocytomas and six were renal cell carcinoma. Growth rate and mass diameter on diagnosis were significantly greater in the group of patients who underwent a surgery. Conclusions. Small renal masses might eventually be managed by active surveillance without compromising survival or surgical approach. All masses that were eventually excised underwent a nephron-sparing surgery. None of the patients developed metastases.

No MeSH data available.


Related in: MedlinePlus

Masses size in both groups as observed at diagnosis and on last follow-up. Blue demonstrates size at diagnosis and red demonstrates size at last available follow-up. Masses diameter at diagnosis was significantly (P = 0.04) smaller in the group of patients who were managed conservatively (18 mm versus 24.9 mm).
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fig2: Masses size in both groups as observed at diagnosis and on last follow-up. Blue demonstrates size at diagnosis and red demonstrates size at last available follow-up. Masses diameter at diagnosis was significantly (P = 0.04) smaller in the group of patients who were managed conservatively (18 mm versus 24.9 mm).

Mentions: Mean tumor diameter at diagnosis for the entire group was 18.7 mm (range 5–40 mm). Patients who remained on active surveillance had significantly smaller masses at diagnosis as compared to patients who underwent surgery, 18 mm (95% CI 15.9, 20.2) and 24.9 mm (95% CI 16.7,33), respectively, P = 0.04. The mean tumor diameter on last available follow-up was 21.4 mm (range 7–40) in the group of patients who remained on active surveillance and 36 mm (range 19–59) in patients who underwent a NSS (Figure 2).


The natural history and predictors for intervention in patients with small renal mass undergoing active surveillance.

Bahouth Z, Halachmi S, Meyer G, Avitan O, Moskovitz B, Nativ O - Adv Urol (2015)

Masses size in both groups as observed at diagnosis and on last follow-up. Blue demonstrates size at diagnosis and red demonstrates size at last available follow-up. Masses diameter at diagnosis was significantly (P = 0.04) smaller in the group of patients who were managed conservatively (18 mm versus 24.9 mm).
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4413980&req=5

fig2: Masses size in both groups as observed at diagnosis and on last follow-up. Blue demonstrates size at diagnosis and red demonstrates size at last available follow-up. Masses diameter at diagnosis was significantly (P = 0.04) smaller in the group of patients who were managed conservatively (18 mm versus 24.9 mm).
Mentions: Mean tumor diameter at diagnosis for the entire group was 18.7 mm (range 5–40 mm). Patients who remained on active surveillance had significantly smaller masses at diagnosis as compared to patients who underwent surgery, 18 mm (95% CI 15.9, 20.2) and 24.9 mm (95% CI 16.7,33), respectively, P = 0.04. The mean tumor diameter on last available follow-up was 21.4 mm (range 7–40) in the group of patients who remained on active surveillance and 36 mm (range 19–59) in patients who underwent a NSS (Figure 2).

Bottom Line: Methods.The mean follow-up period was 34 months (12-112).None of the patients developed metastases.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Bnai Zion Medical Center, 3339414 Haifa, Israel ; Faculty of Medicine, Technion-Israel Institute of Technology, 3200003 Haifa, Israel.

ABSTRACT
Aim. To describe the natural history of small renal mass on active surveillance and identify parameters that could help in predicting the need for intervention in patients with small renal masses undergoing active surveillance. We also discuss the need for renal biopsy in the management of these patients. Methods. A retrospective analysis of 78 renal masses ≤4 cm diagnosed at our Urology Department at Bnai Zion Medical Center between September 2003 and March 2012. Results. Seventy patients with 78 small renal masses were analyzed. The mean age at diagnosis was 68 years (47-89). The mean follow-up period was 34 months (12-112). In 54 of 78 masses there was a growth of at least 2 mm between imaging on last available follow-up and diagnosis. Eight of the 54 (15%) masses which grew in size underwent a nephron-sparing surgery, of which two were oncocytomas and six were renal cell carcinoma. Growth rate and mass diameter on diagnosis were significantly greater in the group of patients who underwent a surgery. Conclusions. Small renal masses might eventually be managed by active surveillance without compromising survival or surgical approach. All masses that were eventually excised underwent a nephron-sparing surgery. None of the patients developed metastases.

No MeSH data available.


Related in: MedlinePlus