Comparison of active surveillance vs. partial nephrectomy results in small renal masses

Abstract

Aim: Incidentally diagnosed renal cancers have increased with the increase in imaging modalities. Incidentally diagnosed masses are smaller in size and there are conflicts in the management of these 3,259 masses. Active surveillance (AS) and surgery are the treatment options. In our study, we aimed to compare the data of patients who underwent these two methods.

Methods: The data of 34 patients who underwent AS and 89 patients who underwent surgery were retrospectively analyzed. AS patients were defined as Group 1 and surgical patients as Group 2. Treatment options were determined according to tumor characteristics, patient age, comorbidities, and surgical risks. The Eastern Cooperative Oncology Group (ECOG) performance score and the Charlson Comorbidity Index (CCI) were used to assess comorbidity in each patient. AS patients were offered surgical treatment when their tumors reached > 4 cm in maximal diameter or had rapid tumor growth rates.

Results: The mean patient age was 74.06 ± 6.78 in Group 1 and 58.82 ± 7.60 in Group 2 (P < 0.001). The ECOG performance score was > 1 in all patients in Group 1, while the rate of ECOG > 1 was 59.6% in Group 2 (P < 0.001). CCI was 8.09 ± 0.75 in Group 1 and 3.94 ± 1.14 in Group 2 (P < 0.001). Mortality rates developed in 10 (29.4%) patients in Group 1 and 3 (3.4%) patients in Group 2. Regarding 5- and 10-year cancer-specific survival (CSS), the 5-year survival rate was 81.1% in Group 1 and 97.7% in Group 2, and the 10-year CSS was 63.2% in Group 1 and 89.5% in Group 2, which was statistically higher in Group 2 (P: 0.0022).

Conclusion: Although AS has worse outcomes than surgery in terms of CSS, it is a recommended option for patients with older age and poor performance scores.

Keywords

Small renal masses / renal cell carcinoma / active surveillance / partial nephrectomy / radical nephrectomy

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