Active surveillance for incidental renal mass in the octogenarian.
OBJECTIVE
To evaluate the oncologic outcomes among a large cohort of octogenarian patients placed on active surveillance for a localized renal mass.


METHODS
We retrospectively reviewed patients ≥80 years of age presenting for asymptomatic, incidentally detected clinically localized stage T1 renal mass between 2006 and 2013 who were followed by active surveillance (AS). The primary endpoint was development of metastatic renal cell carcinoma. Secondary outcomes included intervention-free survival, cancer-specific survival, and overall survival.


RESULTS
Eighty-nine octogenarians (median age = 83.4 years) were placed on AS for a median 29.9 months. Median Charlson Comorbidity Index and Katz Index of Independence in Activities of Daily Living scores were 2 and 5, respectively. For all comers, median initial tumor size was 2.4 cm with median growth rate of 0.20 cm/year. Eight (9.0%) patients failed AS due to delayed intervention and three (1.1%) due to systemic progression after median follow-up of 27.8 and 39.9 months, respectively. Two (2.2%) patients in the delayed intervention cohort developed metastasis after treatment. Tumor growth rate was significantly higher among those undergoing intervention versus no intervention (0.60 vs. 0.15 cm/year, P = 0.05) and among patients with systemic progression versus no metastasis (1.28 vs. 0.18 cm/year, P = 0.001). Five-year intervention-free, metastasis-free, cancer-specific, and overall survivals were 90.6, 95.6, 95.6, and 85.7%, respectively.


CONCLUSIONS
AS represents an effective management strategy in octogenarians given low overall risk of metastasis. Tumor growth kinetics may identify patients at risk of systemic progression in whom treatment should be considered.
Department of Urology, The Arthur Smith Institute for Urology, Northwell Health, 450 Lakeville Road, Suite M41, New Hyde Park, NY, 11040, USA. kenan.celtik@gmail.com.
Kenan E
KE
Celtik
Department of Urology, The Arthur Smith Institute for Urology, Northwell Health, 450 Lakeville Road, Suite M41, New Hyde Park, NY, 11040, USA.
Paras H
PH
Shah
Department of Urology, The Arthur Smith Institute for Urology, Northwell Health, 450 Lakeville Road, Suite M41, New Hyde Park, NY, 11040, USA.
Vinay R
VR
Patel
Department of Urology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55902, USA.
Daniel M
DM
Moreira
Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, Building 10 Room 1-5940, Bethesda, MD, 20892, USA.
Arvin K
AK
George
Department of Urology, The Arthur Smith Institute for Urology, Northwell Health, 450 Lakeville Road, Suite M41, New Hyde Park, NY, 11040, USA.
Valerio
V
Iacovelli
Department of Urology, The Arthur Smith Institute for Urology, Northwell Health, 450 Lakeville Road, Suite M41, New Hyde Park, NY, 11040, USA.
Manaf
M
Alom
Department of Urology, The Arthur Smith Institute for Urology, Northwell Health, 450 Lakeville Road, Suite M41, New Hyde Park, NY, 11040, USA.
Andrew
A
Ng
Department of Urology, Baylor College of Medicine, 7200 Cambridge St #10B, Houston, TX, 77030, USA.
Amin
A
Herati
Department of Urology, University of Michigan, 1500 E. Medical Center Drive, SPC 5330, Ann Arbor, MI, 48109-5330, USA.
Simpa S
SS
Salami
Department of Urology, The Arthur Smith Institute for Urology, Northwell Health, 450 Lakeville Road, Suite M41, New Hyde Park, NY, 11040, USA.
Hannah
H
Bierwiler
Department of Urology, The Arthur Smith Institute for Urology, Northwell Health, 450 Lakeville Road, Suite M41, New Hyde Park, NY, 11040, USA.
Michael J
MJ
Schwartz
Department of Urology, The Arthur Smith Institute for Urology, Northwell Health, 450 Lakeville Road, Suite M41, New Hyde Park, NY, 11040, USA.
Lee
L
Richstone
Department of Urology, The Arthur Smith Institute for Urology, Northwell Health, 450 Lakeville Road, Suite M41, New Hyde Park, NY, 11040, USA.
Joph
J
Steckel
Department of Urology, The Arthur Smith Institute for Urology, Northwell Health, 450 Lakeville Road, Suite M41, New Hyde Park, NY, 11040, USA.
Manish A
MA
Vira
Department of Urology, The Arthur Smith Institute for Urology, Northwell Health, 450 Lakeville Road, Suite M41, New Hyde Park, NY, 11040, USA.
Louis R
LR
Kavoussi
D000369:Aged, 80 and over; D058070:Asymptomatic Diseases / Q000453:epidemiology*; D002292:Carcinoma, Renal Cell / Q000453:epidemiology / Q000473:pathology; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D006801:Humans; D033162:Incidental Findings; D007680:Kidney Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000628:therapy; D008297:Male; D009367:Neoplasm Staging; D010346:Patient Care Management / Q000379:methods / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
Extirpative surgery; Kidney cancer; Renal cell carcinoma; Renal cortical neoplasms; Small renal masses; Watchful waiting