ASCO GU 2018: Does Treatment Approach for Small Renal Masses Affect Survival in Patients 70 Years Old?

San Francisco, CA (UroToday.com) With the advent of modern imaging techniques, small renal masses are being diagnosed more frequently. Many of these masses are benign, and those that are malignant are often low grade and rarely affect survival. Surveillance is more commonly being advocated as an option for these masses. This study elucidates survival following different treatment approaches.

Methods:

The authors analyzed SEER data from 2004-13 and identified 10,477 patients 70 years or older with renal cell carcinoma and tumors greater than or equal to 3 cm. Exclusion criteria included multiple primaries, distant metastasis and node positive disease. Data was collected on demographics, treatment patterns, overall survival and cancer specific survival. Kaplan-Meier analysis and Cox regression models were used to compare outcomes.

Results:

After appropriate exclusions 5,084 patients remained. The mean age was 76.4 years. The mean tumor size was 2.3cm. Tumor laterality was right in 2,610, left in 2,467, bilateral in 2 and unspecified in 5. Racial analysis identified 84% of patients as white, 9% as black and 7% as other. Gender split was 51% male. Treatment methods included 791 ablations and 3,324 surgical resections (radical or partial nephrectomy). The remaining 969 patients did not have treatment (surveillance). Survival was measured at 60 and 118 months. The overall survival was 75% and 54% respectively for ALL patients, 82% and 62% for ablation, 42% and 19% for surveillance and 82% and 62% for resection. Cancer specific survival was 97% and 96% for ablation, 83% and 74% for surveillance and 96% and 94% for resection. Surgical resection or ablation significantly improved survival at 5 and 10 years (p = < 0.0001). Multivariable analysis demonstrated that survival was affected by age and year of diagnosis, but not by tumor size.

Conclusions:

The significant difference in overall survival suggests appropriate selection of patients for surveillance based on medical comorbidities. Treatment with curative intent improves survival in patients with greater than or equal to 3 cm renal masses, even in patients 70 years and older, and must be offered to patients without significant comorbidities.

Presented by: Lukas Hockman, Columbia, Missouri, USA

Co Authors: Tyler Haden, Alex Henderson, Naveen Pokala; University of Missouri Hospital, Columbia, MO; University of Missouri, Columbia, Columbia, MO

Written by: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre @GoldbergHanan at the 2018 American Society of Clinical Oncology Genitourinary (ASCO GU) Cancers Symposium, February 8-10, 2018 - San Francisco, CA

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