Active surveillance of sporadic renal masses: experience from a single tertiary centre
BAUS ePoster online library. Neves J. Jun 27, 2018; 211378; P9-6 Disclosure(s): None
Joana B Neves
Joana B Neves
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Abstract
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Objective: We report on the natural history of renal lesions under active surveillance at a tertiary high-volume referral centre in the UK.
Methods: Retrospective analysis of cases with suspected renal cell carcinoma (RCC) at diagnosis under active surveillance from 2012 to 2017. Patients with confirmed hereditary syndromes were excluded.

Results: 286 patients (62.9% male, median age at diagnosis 71 - IQR 18) with 350 lesions were reviewed. Median lesion size was 24.5mm (IQR 20): 291(83.1%) under 4cm (small renal mass, SRM) and 17(4.6%) above 7cm. 56 lesions were excluded due to lack of follow-up imaging at date of analysis. Median follow-up was 12 months (IQR 20). Histology was known for 135 lesions (45.9%): 73 were RCC, 40 oncocytomas, 9 oncocytic, 10 angiomyolipomas, 2 papillary adenomas, and 1 angiofibroma. During follow-up 156(53.1%) lesions remained stable, 21(7.1%) reduced size and 117(39.8%) increased in size. Increasing lesions grew a median of 4mm/year( IQR 6.6). Focusing on SRM, the median growth was 2.6mm/year(IQR 4.2), and 16(6.6%) went over the 4cm threshold. 31(10.8%) patients changed management after a period of surveillance (17 surgery, 14 percutaneous cryoablation). One patient developed metastasis (cT1b clear cell RCC on a patient unfit for intervention). No cancer specific deaths occurred, but there were 10 non-cancer specific deaths. Study limitations include retrospective nature, lack of central radiological review, and short follow up period.

Conclusions: While our SRM median yearly growth rate is comparable to previous reports, a higher proportion of cases breached the 4cm threshold. Notwithstanding, metastasis-free and cancer-specific survival were close to 100%.
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