aDepartment of Surgical Sciences, University of Bergen, Bergen, Norway;bDepartment of Urology, Haukeland University Hospital, Bergen, Norway;cDepartment of Radiology, Haukeland University Hospital, Bergen, Norway;dDepartment of Pathology, Haukeland University Hospital, Bergen, Norway;eThe Gade Institute, University of Bergen, Bergen, Norway
Abstract:
Background
Renal masses diagnosed in older and comorbid patients represent a challenge with regard to treatment.
Objective
To evaluate clinical outcome and tumor progression in patients with renal masses managed by observation due to age and comorbidity.
Design, setting, and participants
The medical records of 63 consecutive patients with renal masses primarily managed by observation during 2002–2007 were reviewed retrospectively and analyzed. The mean age for all patients at diagnosis was 76.6 yr, and 59% were male. Mean tumor size was 4.3 cm in diameter at diagnosis. Of these, 30% had Eastern Cooperative Oncology Group performance status (PS) of 2 or 3, 78% were American Society of Anesthesiologists (ASA) class 3, and the patients had a mean of 2.8 other medical conditions.
Five-year overall survival (OS) and cancer-specific survival (CSS) rates were 42.8% and 93.3%, respectively. For tumors ≤4.0 cm in size, 5-yr CSS was 100%. Nine patients received delayed radical treatment, none of whom had later progression of the disease. In 18 patients histopathologic diagnosis of the renal masses were available, and in 15 patients (83%) renal cell carcinoma (RCC) was verified. The annual growth rate was <1 cm/yr in 85.4% of the cases. In tumors ≤4.0 cm, only 1 of 27 tumors (3.7%) grew faster than 1 cm/yr.
Conclusions
Management of renal masses by observation among older and comorbid patients seems to give acceptable results with regard to OS and CSS rates after 5 yr. The risk of disease progression is significantly higher in patients with larger sized renal masses (>4 cm). Thus, selection for observation in this group has to be stricter than in a group of patients with smaller sized renal masses (≤4.0 cm).
