Study: Surveillance is safe for small renal masses

February 19, 2013

A large retrospective study of older patients diagnosed with small kidney tumors showed that patients who undergo surgery to remove these tumors have the same risk of dying of kidney cancer over a 5-year period as those who undergo surveillance.

A large retrospective study of older patients diagnosed with small kidney tumors showed that patients who undergo surgery to remove these tumors have the same risk of dying of kidney cancer over a 5-year period as those who undergo surveillance.

Additionally, elderly patients treated with surgery for these small masses may be at greater risk for suffering a cardiovascular event and an earlier death from any cause. The findings, which were presented at the Genitourinary Cancers Symposium in Orlando, FL, suggest that surveillance with imaging, such as magnetic resonance imaging, ultrasound, and computed tomography, is a safe option for the management of small renal masses in the elderly.

"Our analysis indicates that physicians can comfortably tell an elderly patient, especially a patient that is not healthy enough to tolerate general anesthesia and surgery, that the likelihood of dying of kidney cancer is low and that kidney surgery is unlikely to extend their lives," said lead author William C. Huang, MD, of New York University Medical Center in New York. "However, since it is difficult to identify which tumors will become lethal, elderly patients who are completely healthy and have an extended life expectancy may opt for surgery."

In the study, the authors analyzed Surveillance, Epidemiology, and End Results registry data linked to Medicare claims for patients aged 66 years or older who were diagnosed with small renal masses. Out of 8,317 patients, 5,706 (70%) underwent surgery and 2,611 (31%) underwent surveillance. During a median follow-up of 4.8 years, 2,078 patients (25%) died overall, 277 (3%) of kidney cancer. The rates of kidney cancer-related death were the same among patients who received surgery and those who underwent surveillance.

Surveillance was also associated with a markedly lower risk of death from any cause as well as a lower risk of having a cardiovascular event, such as chronic heart failure, ischemic stroke, and vascular disease.

The authors also found that during the years 2000-‘07, the percentage of patients managed with surveillance increased from 25% to 37%.

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