title: Charlson score as a single pertinent criterion to select candidates for active surveillance among patients with small renal masses.
abstract: OBJECTIVE
  The aim of the study was to assess the outcome after nephron-sparing surgery (NSS) of patients with small renal masses (SRMs) who would have been eligible for active surveillance (AS).
  
  
  METHODS
  Data were collected retrospectively for 758 patients who underwent NSS over a 5-year period. Outcomes were assessed in two groups of patients who were eligible for AS according to different criteria. Group 1 criteria were as follows: age >75 years, renal mass ≤4 cm, significant comorbidities [Charlson Comorbidity Index (CCI) >2]. Group 2 criteria were as follows: any SRM ≤ 4 cm regardless of age, severe comorbidities with a 10-year mortality risk >50 % (CCI > 4). The two groups were not compared statistically because some patients were included in both.
  
  
  RESULTS
  Fifty-five patients (7.3 %) were included in Group 1 and 62 (8.2 %) in Group 2. There was a significant proportion of benign tumours in Group 1 (N = 6; 11 %) and Group 2 (N = 6; 10 %). Six (11 %) positive margins were observed in Group 1 and 8 (13 %) in Group 2. The 2- and 5-year recurrence-free survival rates were 100 and 77.4 %, respectively, in Group 1, and 88.5 and 79.6 % in Group 2. The 2- and 5-year overall survival rates were 100 and 74.7 % in Group 1, and 96.7 and 78.1 % in Group 2.
  
  
  CONCLUSIONS
  The majority of patients with SRMs who would have been eligible for AS had no recurrence after initial tumour removal. In these patients, a CCI > 4 appeared to be a pertinent criterion to identify those patients less likely to benefit from immediate surgery.
authors.affiliation: AP-HP, Academic Urology Department, Pitié-Salpêtrière Hospital, 83 bvd de l'Hôpital, 75013, Paris, France.
authors.forename: François
authors.initials: F
authors.lastname: Audenet
authors.forename: Marie
authors.initials: M
authors.lastname: Audouin
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Drouin
authors.forename: Eva
authors.initials: E
authors.lastname: Comperat
authors.forename: Pierre
authors.initials: P
authors.lastname: Mozer
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Chartier-Kastler
authors.forename: Arnaud
authors.initials: A
authors.lastname: Méjean
authors.forename: Olivier
authors.initials: O
authors.lastname: Cussenot
authors.forename: Shahrokh F
authors.initials: SF
authors.lastname: Shariat
authors.forename: Morgan
authors.initials: M
authors.lastname: Rouprêt
mesh_terms: D000236:Adenoma / Q000473:pathology / Q000601:surgery*; D000238:Adenoma, Chromophobe / Q000473:pathology / Q000601:surgery; D018249:Adenoma, Oxyphilic / Q000473:pathology / Q000601:surgery; D000368:Aged; D000369:Aged, 80 and over; D018207:Angiomyolipoma / Q000473:pathology / Q000601:surgery*; D002292:Carcinoma, Renal Cell / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D015897:Comorbidity; D019468:Disease Management; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D060787:Neoplasm Grading; D009392:Nephrectomy / Q000379:methods*; D009399:Nephrons; D059351:Organ Sparing Treatments / Q000379:methods; D018579:Patient Selection; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D057832:Watchful Waiting