Watch and Wait Works for Small Kidney Tumors For tumors less than 4 cm, no increase in risk for kidney cancer death

“Surveillance of small kidney tumors did not increase the risk of dying of kidney cancer,” said William Huang, MD, a surgical oncologist at New York University Langone Medical Center in New York City. In contrast, “surgical treatment, particularly removal of the entire kidney, was associated with cardiovascular complications and poorer survival over time.” He presented the study at the 2013 Genitourinary Cancers Symposium (abstract 343).

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In the current study, researchers set out to identify the effect of surveillance of small renal tumors on morbidity and mortality compared with surgery. They used the Surveillance, Epidemiology, and End Results cancer registry data linked to Medicare claims data, to capture patient comorbidities, for diagnoses between 2000 and 2007. The retrospective cohort study included 8,300 patients who were aged 66 years or older with kidney tumors less than 4 cm. Of these patients, 78% had surgery and 22% received surveillance.

During a median follow-up of five years, patients in the surveillance group had a 16% lower risk for death from any cause compared with the surgical group (hazard ratio [HR], 0.84; 95% confidence interval, 0.75-0.94). Kidney cancer–specific mortality did not differ significantly between the groups.

“Surveillance is a reasonable option, particularly for patients who are older or have a limited life expectancy,” said Dr. Huang. He added that a small number of small tumors can become lethal over a period of time, and therefore if a patient has a normal life expectancy, surgery should still remain the treatment of choice for these patients.

Bruce Roth, MD, a professor of medicine in the Oncology Division at Washington University in St. Louis, who was not involved in the study, said the findings were important in showing that surveillance does not have a negative influence on kidney cancer mortality. He pointed out that today, more small lesions are being identified. “In 2013, it is difficult to go to an emergency room with chest pain or abdominal pain and not come out with a CAT [computed axial tomography] scan,” he said. “The more CAT scans you do, the more kidney masses you are going to find.”