title: Active surveillance for small renal masses diagnosed in elderly or comorbid patients: looking for the best treatment strategy.
abstract: BACKGROUND
  Aim of this study is to provide our results after long-term active surveillance (AS) protocol for small renal masses (SRMs), and to report the outcomes of patients who remained in AS compared to those who underwent delayed surgical intervention.
  
  
  METHODS
  We retrospectively reviewed our database of 58 patients diagnosed with 60 contrast enhancing SRMs suspicious for renal cell carcinoma (RCC). All patients had clinical and radiological follow-up every 6 months. We evaluated the differences between patients who remained on AS and those who underwent surgical delayed intervention.
  
  
  RESULTS
  The mean age was 75 years, the mean follow-up was 88.5 months. The median initial tumor size at presentation was 2.6cm, and the median estimated tumor volume was 8.7cm(3). The median linear growth rate of the cohort was 0.7cm/year, and the median volumetric growth rate was 8.8 cm(3)/year. Death for metastatic disease occurred in 2 patients (3.4%). No correlation was found between initial tumor size and size growth rate. The mean linear and volumetric growth rates of the group of patients who underwent surgery was higher than in those who remained on surveillance (1.9 vs. 0.4cm/year and 16.1 vs. 4.6 cm(3)/year, respectively; P<.001).
  
  
  CONCLUSIONS
  Most of SRMs demonstrate to have an indolent course and low metastatic potential. Malignant disease could have faster linear and volumetric growth rates, thus suggesting the need for a delayed surgical intervention. In properly selected patients with low life-expectancy, AS could be a reasonable option in the management of SRMs.
authors.affiliation: Department of Urology, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italia.
authors.forename: E
authors.initials: E
authors.lastname: Brunocilla
authors.affiliation: Department of Urology, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italia. Electronic address: mark.borghesi@gmail.com.
authors.forename: M
authors.initials: M
authors.lastname: Borghesi
authors.affiliation: Department of Urology, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italia.
authors.forename: R
authors.initials: R
authors.lastname: Schiavina
authors.affiliation: Department of Urology, S. Maria delle Croci Hospital, Ravenna, Italia.
authors.forename: F
authors.initials: F
authors.lastname: Palmieri
authors.affiliation: Department of Urology, S. Maria delle Croci Hospital, Ravenna, Italia.
authors.forename: R
authors.initials: R
authors.lastname: Pernetti
authors.affiliation: Department of Radiology, M.F. Toniolo Hospital, Bologna, Italia.
authors.forename: C
authors.initials: C
authors.lastname: Monti
authors.affiliation: Department of Urology, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italia.
authors.forename: G
authors.initials: G
authors.lastname: Martorana
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000150:complications / Q000473:pathology / Q000628:therapy*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000150:complications / Q000473:pathology / Q000628:therapy*; D008297:Male; D012189:Retrospective Studies; D057832:Watchful Waiting
keywords: Active surveillance; Cáncer de células renales; Follow-up; Masas renales pequeñas; Renal cell carcinoma; Seguimiento; Small renal masses; Vigilancia activa