FCCC LOGO Faculty Publications
Kunkle DA , Crispen PL , Chen DYT , Greenberg RE , Uzzo RG
Enhancing renal masses with zero net growth during active surveillance
Journal of Urology. 2007 Mar;177(3) :849-853
PMID: ISI:000244211600007   
Back to previous list
Abstract
Purpose: The natural history of small renal masses is generally to slowly increase in size. However, a subset of lesions does not show radiographic growth. We compared clinical, radiographic and pathological characteristics of enhancing renal masses under active surveillance with zero net radiographic growth vs those with positive growth. Materials and Methods: We identified 106 enhancing renal masses that were observed for 12 months or greater. Lesions were grouped according to growth characteristics. Group 1 consisted of lesions demonstrating zero or negative growth. Group 2 tumors showed positive growth during surveillance. Clinical, radiographic and pathological parameters were then compared. A MEDLINE (R) search was performed regarding zero growth lesions during observation for suspected renal cell carcinoma in the world literature. Results: Group 1 consisted of 35 lesions (33%) with a median growth rate of 0.0 cm yearly. Group 2 included 70 lesions (67%) showing growth at 0.31 cm yearly (p < 0.0001). No differences were detected with regard to patient age (p = 0.96), lesion size (p = 0.41), solid/cystic appearance (p = 1.00) or the incidental detection rate (p 0.38). While 17% of group 1 lesions (6 of 35) underwent intervention, 51% (36 of 71) in group 2 were ultimately treated (p = 0.001). Pathological assessment showed a similar incidence of malignancy in groups 1 and 2 (83% and 89%, respectively, p = 0.56). A literature review revealed that 78 of 295 observed lesions (26%) failed to demonstrate radiographic growth. Conclusions: We were unable to identify definable clinical characteristics to predict the future growth of enhancing renal masses under active surveillance. Our analysis demonstrated that 26% to 33% of these tumors do not demonstrate growth at 29 months median follow up. These lesions have similar rates of malignancy compared to growing lesions and rates of progression to metastatic disease are similarly low. A brief period of active surveillance may be feasible with treatment limited to lesions that increase in size.
Notes
ISI Document Delivery No.: 136GW Times Cited: 0 Cited Reference Count: 20 Cited References: BOSNIAK MA, 1995, RADIOLOGY, V197, P589 CHAWLA SN, 2006, J UROLOGY, V175, P425 CLARK JI, 2003, J CLIN ONCOL, V21, P3133 DUFFEY BG, 2004, J UROLOGY, V172, P63 FRANK I, 2003, J UROLOGY 1, V170, P2217 FRANK I, 2005, J UROLOGY, V173, P1889 FUJIMOTO N, 1995, INT J UROL, V2, P71 HEFEZ KS, 1999, J UROLOGY, V162, P1930 JAYSON M, 1998, UROLOGY, V51, P203 KASSOUF W, 2004, J UROLOGY, V171, P111 KATO M, 2004, J UROLOGY, V172, P863 LAMB GWA, 2004, UROLOGY, V64, P909 LANE BR, 2006, AUA UPDATE SERIES, V25, P57 MOINZADEH A, 2006, J UROLOGY, V175, P459 NEGRIER S, 1998, NEW ENGL J MED, V338, P1272 ODA T, 2001, INT J UROL, V8, P473 RENDON RA, 2000, J UROLOGY, V164, P1143 SOWERY RD, 2004, CAN J UROL, V11, P2407 VOLPE A, 2004, CANCER, V100, P738 WEHLE MJ, 2004, UROLOGY, V64, P49 Kunkle, David A. Crispen, Paul L. Chen, David Y. T. Greenberg, Richard E. Uzzo, Robert G.