title: Active surveillance for clinically localized renal tumors: An updated review of current indications and clinical outcomes.
abstract: The widespread use of abdominal imaging has led to an increasing detection of small renal masses, and approximately 20-30% of those tumors will prove to be benign, with low metastatic potential if not immediately treated. In elderly or comorbid patients diagnosed with small renal masses, competing cause mortality seems to exceed cancer-specific mortality at short- and intermediate-term follow up. In these cases, surgery might represent an overtreatment, and an expectant management, such as active surveillance, might be proposed. According to the current available evidence, active surveillance is a safe and reasonable option for patients with renal tumors ≤4 cm (cT1a) and short life expectancy. A few studies with short-term follow up reported the preliminary results of active surveillance even in cT1b-cT2 tumors, with acceptable risk of disease progression and mortality, even if this approach should be considered in this setting only for highly-selected and well-informed patients. Furthermore, surveillance protocols can be proposed in selected patients with uncomplicated benign tumors, such as angiomyolipomas, in which active surveillance should be considered the initial standard management. At present, reliable clinical predictors of a tumor's growth rate and aggressiveness are not available. Renal tumor biopsy is useful in the clinical work-up of patients who are candidates for active surveillance, in order to improve patient selection based on tumor histological characterization. Despite the proof of safety offered by expectant management for small renal masses in selected patients, further prospective studies with longer follow up are required in order to confirm the indications and long-term oncological outcomes of active surveillance protocols for renal tumors.
authors.affiliation: Department of Urology, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy; Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Borghesi
authors.forename: Eugenio
authors.initials: E
authors.lastname: Brunocilla
authors.forename: Alessandro
authors.initials: A
authors.lastname: Volpe
authors.forename: Hussam
authors.initials: H
authors.lastname: Dababneh
authors.forename: Cristian Vincenzo
authors.initials: CV
authors.lastname: Pultrone
authors.forename: Valerio
authors.initials: V
authors.lastname: Vagnoni
authors.forename: Gaetano
authors.initials: G
authors.lastname: La Manna
authors.forename: Angelo
authors.initials: A
authors.lastname: Porreca
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Martorana
authors.forename: Riccardo
authors.initials: R
authors.lastname: Schiavina
mesh_terms: D018207:Angiomyolipoma / Q000175:diagnosis*; D001706:Biopsy; D002292:Carcinoma, Renal Cell / Q000175:diagnosis* / Q000473:pathology; D015897:Comorbidity; D003952:Diagnostic Imaging; D018450:Disease Progression; D006801:Humans; D007680:Kidney Neoplasms / Q000175:diagnosis* / Q000473:pathology; D011446:Prospective Studies
keywords: active surveillance; clinically localized renal tumors; percutaneous biopsy; renal cell carcinoma; small renal mass