Surveillance, or the watch and wait approach, may be the best option for older patients with small kidney tumors.
The finding came from a large retrospective study which showed that surveillance is a safe alternative to surgery. The research will be presented at the American Society of Clinical Oncology (ASCO) conference on Saturday.
The results of the investigation indicated that older patients with small kidney tumors, less than 1.5 inches in diameter, who remove them with surgery have the same likelihood of dying of kidney cancer over a five-year period as those who undergo surveillance.
The researchers also discovered that elderly patients who undergo surgery for these small masses may have an increased chance of experiencing a cardiovascular event and an earlier death from any cause.
The study indicates that a safe option for the management of small renal masses in elderly people is surveillance with imaging, such as:
William C. Huang, MD, Assistant Professor of Urologic Oncology at New York University Medical Center in New York and lead author, explained:
“Our analysis indicates that physicians can comfortably tell an elderly patient, especially a patient that is not healthy enough to tolerate general anesthesia and surgery, that the likelihood of dying of kidney cancer is low and that kidney surgery is unlikely to extend their lives. However, since it is difficult to identify which tumors will become lethal, elderly patients who are completely healthy and have an extended life expectancy, may opt for surgery.”
When a person undergoes an ultrasound, MRI imaging, or CT for conditions not associated with small renal tumors, such as abdominal pain, back pain, or gallstones, the tumors are often identified by accident – in 3 out of 4 cases.
Most patients with a small renal mass choose to have surgery, which means that either part of the kidney or the whole kidney will be removed.
However, the authors explained, new studies are demonstrating that the risk of surgery may be greater than the benefits for elderly people or individuals with co-morbid conditions and limited life expectancy.
For the purpose of the research, the experts gathered and examined SEER registry data associated with Medicare claims for patients aged 66 years or older who had small renal masses.
The team analyzed 8,317 patients, 70% (5,706) received surgery and 31% (2,611) underwent surveillance.
Twenty-five percent (2,078) of the subjects died during a median follow up of 4.8 years, kidney cancer was responsible for 3% (277) of those deaths.
Kidney cancer-related death rates were the same for the patients who received surgery and those who chose surveillance.
Surveillance was linked to a notably lower chance of dying from any cause and a reduced risk of experiencing a cardiovascular event, such as vascular disease, ischemic stroke, and chronic heart failure.
From 2000 to 2007, the number of patients who underwent surveillance increased between 25 to 37%.
According to the scientists, physicians are starting to become aware that several small tumors are not threatening, even when they are malignant.
Doctors also have increased awareness that removing the kidney can cause chronic kidney disease, which is linked to kidney failure, heart issues, and early death.
The authors said: “While 8 out of 10 small renal masses are malignant tumors, they generally don’t pose an immediate threat because they normally grow slowly and only a small number of them metastasize. Surveillance allows doctors to intervene if the tumor exhibits an aggressive growth rate or reaches a size that indicates a greater potential for spreading.”
Huang concluded:
“The risk of dying of kidney cancer in a person diagnosed with a small renal mass is small but real. So, treatment considerations are different for healthy individuals, because they have a long life expectancy and a greater chance of having progression and spread of the disease.”
Written by Sarah Glynn