title: Small renal masses in the era of personalized medicine: Tumor heterogeneity, growth kinetics, and risk of metastasis.
abstract: Small renal masses (SRMs) represent a heterogeneous group showing a variety of clinical and biological behaviors. The best treatment for SRMs has been the focus of much debate over the past decades. Present strategies include surgery (partial or radical nephrectomy), local treatments (radiofrequency and cryoablation), or active surveillance. The choice among these therapeutic options is based on patient clinical features such as age or comorbidities rather than on tumor characteristics. Several studies have recently focused on the molecular behavior of SRMs. They showed that SRMs present histotype and nuclear grading heterogeneity, together with not unvarying growth kinetics and risk of recurrence or metastasis, suggesting that personalized approaches should be designed to optimize the management of these patients. At present, several studies are in course to identify predictive biomarkers to guide the decision-making process in this subpopulation. In this review, we summarized the data on growth kinetics, tumor heterogeneity, and risk of metastasis in patients with SRMs, with focus on the current role of biopsies and imaging in the management of these patients.
authors.affiliation: Department of Odontostomatologic and Specialized Clinical Sciences, Polytechnic University of the Marche Region, School of Medicine, Ancona, Italy; Department of Urology, Odense University Hospital, Odense C, Denmark. Electronic address: alessandro.conti@hotmail.com.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Conti
authors.affiliation: Medical Oncology, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I-GM Lancisi-G Salesi, Ancona, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Santoni
authors.affiliation: Medical Oncology, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I-GM Lancisi-G Salesi, Ancona, Italy.
authors.forename: Valeria
authors.initials: V
authors.lastname: Sotte
authors.affiliation: Medical Oncology, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I-GM Lancisi-G Salesi, Ancona, Italy.
authors.forename: Luciano
authors.initials: L
authors.lastname: Burattini
authors.affiliation: Section of Pathological Anatomy, Polytechnic University of the Marche Region, School of Medicine, AOU Ospedali Riuniti, Ancona, Italy.
authors.forename: Marina
authors.initials: M
authors.lastname: Scarpelli
authors.affiliation: Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN.
authors.forename: Liang
authors.initials: L
authors.lastname: Cheng
authors.affiliation: Department of Surgery, Cordoba University Medical School, Cordoba, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Lopez-Beltran
authors.affiliation: Section of Pathological Anatomy, Polytechnic University of the Marche Region, School of Medicine, AOU Ospedali Riuniti, Ancona, Italy.
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Montironi
authors.affiliation: Medical Oncology, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I-GM Lancisi-G Salesi, Ancona, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Cascinu
authors.affiliation: Department of Odontostomatologic and Specialized Clinical Sciences, Polytechnic University of the Marche Region, School of Medicine, Ancona, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Muzzonigro
authors.affiliation: Department of Urology, Odense University Hospital, Odense C, Denmark; Clinical Institute, University of Southern Denmark, Odense C, Denmark.
authors.forename: Lars
authors.initials: L
authors.lastname: Lund
mesh_terms: D002292:Carcinoma, Renal Cell / Q000453:epidemiology / Q000556:secondary* / Q000628:therapy; D006801:Humans; D007680:Kidney Neoplasms / Q000453:epidemiology / Q000473:pathology* / Q000628:therapy; D057285:Precision Medicine / Q000379:methods; D012307:Risk Factors
keywords: Active surveillance; Diagnosis; Nephrectomy; Renal biopsy; Small renal masses; Tumor heterogeneity