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Surveillance of small kidney tumors safe for older patients
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Older patients who undergo surgery to remove small kidney tumors have the same mortality rate as those who undergo surveillance, according to results of a retrospective cohort study presented at the Genitourinary Cancers Symposium.
Nearly two-thirds of newly diagnosed kidney cancers are considered small (<4 cm). Surgery to remove part of or the entire kidney is the standard treatment for these cancers.
Emerging evidence suggests the risk of surgery in older or morbidly ill patients may be unnecessary and possibly affect non-oncologic outcomes, according to background information provided by researchers.
“The objective of this study was to look at the utilization patterns of surveillance in small kidney tumors and also to examine the impact of surveillance on oncologic outcomes, morbidity and mortality compared with surgical intervention,” William C. Huang, MD, assistant professor of urologic oncology at New York University Medical Center, said in a press conference prior to the symposium.
Huang and colleagues used SEER registry data linked to Medicare claims to identify patients aged 66 years or older who were diagnosed with small renal masses between 2000 and 2007.
Of the 8,317 patients evaluated, 5,706 (68.6%) underwent surgery and 2,611(31.3%) underwent surveillance, defined as no registered treatment within 6 months of diagnosis.
The use of surveillance increased from 25% in 2000 to 37% in 2007 (P<.001).
OS, cancer-specific survival and cardiovascular events served as the primary outcome measures.
During a median follow-up of 59 months, 2,053 patients (24.6%) had at least one cardiovascular event, and 2,078 patients (24.9%) died. Notably, only 277 patients (3%) died of kidney cancer.
Compared with surgery, surveillance was associated with a significantly lower risk of death from any cause, study results showed (HR=0.84; 95% CI, 0.75-0.94).
When researchers controlled for patient and disease characteristics, surveillance significantly lowered the risk of a cardiovascular event — such as chronic heart failure, ischemic stroke and vascular disease — compared with surgery (HR=0.79; 95% CI, 0.70-0.89).
“We believe surveillance is a reasonable option, particularly for patients who are older or have a limited life expectancy,” Huang said. “A small number of small tumors can become lethal over time. Therefore, if a patient does have a normal life expectancy, surgery should still remain the treatment of choice.”
For more information:
Huang WC. Abstract #343. Presented at: Genitourinary Cancers Symposium; Feb. 14-16, 2013; Orlando.
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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Bruce J. Roth, MD
This is an important study because it shows watching these small tumors does not have a negative impact on kidney cancer mortality. It also shows that the decision to perform surgery on these individuals may have a negative impact because they’ll have an increased risk of cardiovascular events and cardiovascular mortality. That is an important observation, and it helps patients realize that a watchful and patient approach with lesions like this is a reasonable thing to do medically.
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