Growth kinetics of small renal masses: A prospective analysis from the Renal Cell Carcinoma Consortium of Canada

Authors

  • Michael Organ Dalhousie University
  • Michael Jewett University of Toronto
  • Joan Basiuk
  • Christopher Morash University of Ottawa
  • Stephen Pautler University of Western Ontario
  • Robert Siemens Queen's University
  • Simon Tanguay McGill University
  • Martin Gleave Vancouver General Hospital
  • Darrell Drachenberg University of Manitoba
  • Raymond Chow Princess Margaret Hospital
  • Joseph Chin University of Western Ontario
  • Andrew Evans University of Toronto
  • Neil Fleshner University of Toronto
  • Andrew Evans University of Toronto
  • Brenda Gallie University of Toronto
  • Masoom Haider University of Toronto
  • John Kachura University of Toronto
  • Antonio Finelli University of Toronto
  • Ricardo Rendon Dalhousie University

DOI:

https://doi.org/10.5489/cuaj.1483

Keywords:

Active Surveillance, Growth Rate, Prognosis, Renal Cell Carcinoma, Renal Mass

Abstract

Introduction: Most small renal masses (SRMs) are diagnosed incidentally and have a low malignant potential. As more elderly patients and infirm patients are diagnosed with SRMs, there is an increased interest in active surveillance (AS) with delayed intervention. Patient and tumour characteristics relating to aggressive disease have not been well-studied. The objective was to determine predictors of growth of SRMs treated with AS.

Methods: A multicentre prospective phase 2 clinical trial was conducted on 207 SRMs in 169 patients in 8 institutions in Canada from 2004 to 2009; in these patients treatment was delayed until disease progression. Patient and tumour characteristics were evaluated to determine predictors of growth of SRMs by measuring rates of change in growth (on imaging) over time. All patients underwent AS for presumed renal cell carcinoma (RCC) based on diagnostic imaging. We used the following factors to develop a predictive model of tumour growth with binary recursive partitioning analysis: patient characteristics (age, symptoms at diagnosis) and tumour characteristics (consistency [solid vs. cystic] and maximum diameter at diagnosis.

Results: With a median follow-up of 603 days, 169 patients (with 207 SRMs) were followed prospectively. Age, symptoms at diagnosis, tumour consistency and maximum diameter of the renal mass were not predictors of growth. This cohort was limited by lack of availability of patient and tumour characteristics, such as sex, degree of endophytic component and tumour location.

Conclusion: Slow growth rates and the low malignant potential of SRMs have led to AS as a treatment option in the elderly and infirm population. In a large prospective cohort, we have shown that age, symptoms, tumour consistency and maximum diameter of the mass at diagnosis are not predictors of growth of T1a lesions. More knowledge on predictors of growth of SRMs is needed.

Downloads

Download data is not yet available.

Downloads

Published

2014-02-10

How to Cite

Organ, M., Jewett, M., Basiuk, J., Morash, C., Pautler, S., Siemens, R., Tanguay, S., Gleave, M., Drachenberg, D., Chow, R., Chin, J., Evans, A., Fleshner, N., Evans, A., Gallie, B., Haider, M., Kachura, J., Finelli, A., & Rendon, R. (2014). Growth kinetics of small renal masses: A prospective analysis from the Renal Cell Carcinoma Consortium of Canada. Canadian Urological Association Journal, 8(1-2), 24–7. https://doi.org/10.5489/cuaj.1483

Issue

Vol. 8 No. 1-2 (2014): CUAJ February

Section

Original Research

License

You, the Author(s), assign your copyright in and to the Article to the Canadian Urological Association. This means that you may not, without the prior written permission of the CUA:

  • Post the Article on any Web site
  • Translate or authorize a translation of the Article
  • Copy or otherwise reproduce the Article, in any format, beyond what is permitted under Canadian copyright law, or authorize others to do so
  • Copy or otherwise reproduce portions of the Article, including tables and figures, beyond what is permitted under Canadian copyright law, or authorize others to do so.

The CUA encourages use for non-commercial educational purposes and will not unreasonably deny any such permission request.

You retain your moral rights in and to the Article. This means that the CUA may not assert its copyright in such a way that would negatively reflect on your reputation or your right to be associated with the Article.

The CUA also requires you to warrant the following:

  • That you are the Author(s) and sole owner(s), that the Article is original and unpublished and that you have not previously assigned copyright or granted a licence to any other third party;
  • That all individuals who have made a substantive contribution to the article are acknowledged;
  • That the Article does not infringe any proprietary right of any third party and that you have received the permissions necessary to include the work of others in the Article; and
  • That the Article does not libel or violate the privacy rights of any third party.