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Effect of lesion dimension on survival in patients with T1a renal cell carcinoma who underwent deferred surgery

  • Urology - Original Paper
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Abstract

Background

Small renal masses (SRMs) have been shown to have low malignant potential. Active surveillance (AS), typically characterized by regular follow-up and delayed nephrectomy if necessary, is recommended as an option for frail patients with SRMs. Nevertheless, the impact of tumor size on survival in T1a RCC patients undergoing delayed nephrectomy for SRMs remains unclear.

Methods

Patients diagnosed with non-metastatic T1a RCC who underwent nephrectomy were identified from the Surveillance, Epidemiology, and End Results (SEER) database and divided into immediate (< 6 months) and delayed nephrectomy (≥ 6 months) groups based on the duration from diagnosis to nephrectomy. After propensity score matching (PSM), overall survival (OS) and cancer-specific survival (CSS) were estimated by K-M curves and compared with log-rank test.

Results

A total of 27,502 patients were enrolled, of whom 26,915 (97.9%) received immediate nephrectomy and 587 (2.1%) received delayed nephrectomy. After PSM, 1174 patients who underwent immediate nephrectomy and 587 patients who underwent delayed nephrectomy were included. With a median delay of 7 months, delayed nephrectomy resulted in non-inferior OS for RCC tumors sized 0.1–2.0 cm (HR = 1.12, p = 0.636). However, for RCC tumors sized 2.1–3.0 cm (HR = 1.60, p = 0.008) and 3.1–4.0 cm (HR = 1.89, p < 0.001), delayed nephrectomy showed inferior OS compared to immediate nephrectomy. Delayed nephrectomy did not result in significantly worse CSS than immediate nephrectomy in all tumor size subgroups (all p > 0.05), however this may be due to sample size limiting statistical power.

Conclusion

Based on the SEER database, we found that with a median delay of 7 months, 2 cm may be an appropriate cut-off point of delayed nephrectomy for patients diagnosed with non-metastatic T1a RCC.

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Data availability

The data that support the findings of this study are openly available in seer.cancer.gov.

References

  1. Sung H et al (2021) Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 71(3):209–249

    Article  PubMed  Google Scholar 

  2. Chow WH et al (1999) Rising incidence of renal cell cancer in the United States. JAMA 281(17):1628–1631

    Article  CAS  PubMed  Google Scholar 

  3. Kane CJ et al (2008) Renal cell cancer stage migration: analysis of the national cancer data base. Cancer 113(1):78–83

    Article  PubMed  Google Scholar 

  4. Campbell SC et al (2021) Renal mass and localized Renal cancer: evaluation, management, and follow-up: AUA guideline: part I. J Urol 206(2):199–208

    Article  PubMed  Google Scholar 

  5. Ljungberg B et al (2022) European association of urology guidelines on renal cell carcinoma: the 2022 update. Eur Urol 82(4):399–410

    Article  PubMed  Google Scholar 

  6. Motzer RJ et al (2022) Kidney cancer, version 3.2022, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw 20(1):71–90

    Article  PubMed  PubMed Central  Google Scholar 

  7. Taneja SS (2017) Small renal mass. Urol Clin North Am 44(2):xv

    Article  PubMed  Google Scholar 

  8. Jewett MA et al (2011) Active surveillance of small renal masses: progression patterns of early stage kidney cancer. Eur Urol 60(1):39–44

    Article  PubMed  Google Scholar 

  9. Pecoraro A et al (2021) Comparison between small renal masses 0–2 cm vs. 2.1–4 cm in size: a population-based study. Urol Oncol 39(4):239.e1-239.e7

    Article  PubMed  Google Scholar 

  10. Pecoraro A et al (2020) Small renal masses with tumor size 0 to 2 cm: A SEER-based study and validation of NCCN guidelines. J Natl Compr Canc Netw 18(10):1340–1347

    Article  PubMed  Google Scholar 

  11. Pierorazio PM et al (2015) Five-year analysis of a multi-institutional prospective clinical trial of delayed intervention and surveillance for small renal masses: the DISSRM registry. Eur Urol 68(3):408–415

    Article  PubMed  Google Scholar 

  12. Amin MB et al (2017) The eighth edition AJCC cancer Staging manual: continuing to build a bridge from a population-based to a more “personalized” approach to cancer staging. CA Cancer J Clin 67(2):93–99

    Article  PubMed  Google Scholar 

  13. Capitanio U et al (2022) A Renewal of the TNM Staging system for patients with renal cancer to comply with current decision-making: Proposal from the European association of urology guidelines panel. Eur Urol. https://doi.org/10.1016/j.eururo.2022.09.026

    Article  PubMed  PubMed Central  Google Scholar 

  14. Tang Y et al (2022) Re: Umberto Capitanio, Jens Bedke, Laurence Albiges, et al. A Renewal of the TNM Staging System for Patients with Renal Cancer To Comply with Current Decision-making: Proposal from the European Association of Urology Guidelines Panel. Eur Urol In press. https://doi.org/10.1016/j.eururo.2022.09.026

  15. Huang WC et al (2013) Surveillance for the management of small renal masses: outcomes in a population-based cohort. J Urol 189:e483

    Article  Google Scholar 

  16. Hyams ES et al (2012) Partial nephrectomy vs. non-surgical management for small renal massess: a population-based comparison of disease-specific and overall survival. J Urol 187:e678

    Article  Google Scholar 

  17. Sun M et al (2013) Management of localized kidney cancer: calculating cancer specific mortality and competing-risks of death tradeoffs between surgery and acive surveillance. J Urol 189:e672

    Article  Google Scholar 

  18. Xing M et al (2018) Comparative effectiveness of thermal ablation, surgical resection, and active surveillance for T1a renal cell carcinoma: a surveillance, epidemiology, and end results (SEER)-medicare-linked population study. Radiology 288(1):81–90

    Article  PubMed  Google Scholar 

  19. Tang Y et al (2022) The impact of tumor size on the survival of patients with small renal masses: a population-based study. Cancer Med 11(12):2377–2385

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Finelli A et al (2020) Small renal mass surveillance: histology-specific growth rates in a biopsy-characterized cohort. Eur Urol 78(3):460–467

    Article  PubMed  Google Scholar 

  21. Pecoraro A et al (2021) Synchronous metastasis rates in T1 renal cell carcinoma: a surveillance, epidemiology, and end results database-based study. Eur Urol Focus 7(4):818–826

    Article  PubMed  Google Scholar 

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Acknowledgements

We thank for high-quality data provided by Surveillance, Epidemiology, and End Results database.

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Author notes

  1. Lin Wang and Long Huang these authors contributed equally to this study.

Authors and Affiliations

  1. Department of Urology, 363 Hospital, Chengdu, 610041, China

    Lin Wang, Long Huang, Lei Lei, Yan Xu, Lijuan Huang, Hong Liu, Haiyan Wang & Dongliang Liu

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  1. Lin Wang
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  4. Yan Xu
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All listed authors contributed to data collection, collation, analysis, and writing of the.manuscript and approved the submission of the manuscript.

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Correspondence to Dongliang Liu.

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The study was derived from a public database, and sensitive patient information has been obscured, so the study was exempt from ethical approval and informed consent from the Institutional Review Board.

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Wang, L., Huang, L., Lei, L. et al. Effect of lesion dimension on survival in patients with T1a renal cell carcinoma who underwent deferred surgery. Int Urol Nephrol (2024). https://doi.org/10.1007/s11255-024-04041-5

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