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Oncological Outcomes of Active Surveillance Versus Surgery or Ablation for Patients With Small Renal Masses: A Systematic Review and Quantitative Analysis Publisher Pubmed



Tsuboi I1, 4, 9, 11, 13, 15, 17, 19, 21, 23, 25, 27, 30, 32 ; Rajwa P1, 4, 9, 11, 13, 15, 17, 19, 21, 23, 25, 27, 30, 32 ; Campi R6 ; Miszczyk M1, 4, 9, 11, 13, 15, 17, 19, 21, 23, 25, 27, 30, 32 ; Fazekas T1, 4, 9, 11, 13, 15, 17, 19, 21, 23, 25, 27, 30, 32 ; Matsukawa A1, 4, 9, 11, 13, 15, 17, 19, 21, 23, 25, 27, 30, 32 ; Kardoust Parizi M1, 4, 9, 11, 13, 15, 17, 19, 21, 23, 25, 27, 30, 32 ; Schulz RJ1, 4, 9, 11, 13, 15, 17, 19, 21, 23, 25, 27, 30, 32 ; Mancon S1, 4, 9, 11, 13, 15, 17, 19, 21, 23, 25, 27, 30, 32 ; Cadenar A1, 4, 9, 11, 13, 15, 17, 19, 21, 23, 25, 27, 30, 32 ; Laukhtina E1, 4, 9, 11, 13, 15, 17, 19, 21, 23, 25, 27, 30, 32 ; Kawada T1, 4, 9, 11, 13, 15, 17, 19, 21, 23, 25, 27, 30, 32 ; Katayama S1, 4, 9, 11, 13, 15, 17, 19, 21, 23, 25, 27, 30, 32 ; Iwata T1, 4, 9, 11, 13, 15, 17, 19, 21, 23, 25, 27, 30, 32 Show All Authors
Authors
  1. Tsuboi I1, 4, 9, 11, 13, 15, 17, 19, 21, 23, 25, 27, 30, 32
  2. Rajwa P1, 4, 9, 11, 13, 15, 17, 19, 21, 23, 25, 27, 30, 32
  3. Campi R6
  4. Miszczyk M1, 4, 9, 11, 13, 15, 17, 19, 21, 23, 25, 27, 30, 32
  5. Fazekas T1, 4, 9, 11, 13, 15, 17, 19, 21, 23, 25, 27, 30, 32
  6. Matsukawa A1, 4, 9, 11, 13, 15, 17, 19, 21, 23, 25, 27, 30, 32
  7. Kardoust Parizi M1, 4, 9, 11, 13, 15, 17, 19, 21, 23, 25, 27, 30, 32
  8. Schulz RJ1, 4, 9, 11, 13, 15, 17, 19, 21, 23, 25, 27, 30, 32
  9. Mancon S1, 4, 9, 11, 13, 15, 17, 19, 21, 23, 25, 27, 30, 32
  10. Cadenar A1, 4, 9, 11, 13, 15, 17, 19, 21, 23, 25, 27, 30, 32
  11. Laukhtina E1, 4, 9, 11, 13, 15, 17, 19, 21, 23, 25, 27, 30, 32
  12. Kawada T1, 4, 9, 11, 13, 15, 17, 19, 21, 23, 25, 27, 30, 32
  13. Katayama S1, 4, 9, 11, 13, 15, 17, 19, 21, 23, 25, 27, 30, 32
  14. Iwata T1, 4, 9, 11, 13, 15, 17, 19, 21, 23, 25, 27, 30, 32
  15. Bekku K1, 4, 9, 11, 13, 15, 17, 19, 21, 23, 25, 27, 30, 32
  16. Wada K1, 4, 9, 11, 13, 15, 17, 19, 21, 23, 25, 27, 30, 32
  17. Karakiewicz PI29
  18. Remzi M1, 4, 9, 11, 13, 15, 17, 19, 21, 23, 25, 27, 30, 32
  19. Araki M3, 26, 31
  20. Shariat SF1, 4, 9, 11, 13, 15, 17, 19, 21, 23, 25, 27, 30, 32
Show Affiliations
Authors Affiliations
  1. 1. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
  2. 2. Department of Urology, Shimane University Faculty of Medicine, Shimane, Japan
  3. 3. Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
  4. 4. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
  5. 5. Second Department of Urology, Centre of Postgraduate Medical Education, Warsaw, Poland
  6. 6. Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
  7. 7. Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
  8. 8. European Association of Urology Young Academic Urologists Renal Cancer Working Group, Arnhem, The Netherlands
  9. 9. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
  10. 10. Collegium Medicum Faculty of Medicine, WSB University, Dabrowa Gornicza, Poland
  11. 11. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
  12. 12. Department of Urology, Semmelweis University, Budapest, Hungary
  13. 13. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
  14. 14. Department of Urology, Jikei University School of Medicine, Tokyo, Japan
  15. 15. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
  16. 16. Department of Urology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
  17. 17. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
  18. 18. Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
  19. 19. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
  20. 20. Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
  21. 21. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
  22. 22. Unit of Oncologic Minimally Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Florence, Italy
  23. 23. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
  24. 24. Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
  25. 25. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
  26. 26. Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
  27. 27. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
  28. 28. Department of Urology, Shimane University Faculty of Medicine, Shimane, Japan
  29. 29. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, Canada
  30. 30. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
  31. 31. Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
  32. 32. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
  33. 33. Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
  34. 34. Department of Urology, Weill Cornell Medical College, New York, NY, USA
  35. 35. Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czechia
  36. 36. Division of Urology, Department of Special Surgery, The University of Jordan, Amman, Jordan
  37. 37. Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria
  38. 38. Department of Urology, Semmelweis University, Budapest, Hungary
  39. 39. Research Center for Evidence Medicine, Urology Department, Tabriz University of Medical Sciences, Tabriz, Iran

Source: European urology oncology Published:2025


Abstract

BACKGROUND AND OBJECTIVE: While active surveillance (AS) is an alternative to surgical interventions in patients with small renal masses (SRMs), evidence regarding its oncological efficacy is still debated. We aimed to evaluate oncological outcomes for patients with SRMs who underwent AS in comparison to surgical interventions. METHODS: In April 2024, PubMed, Scopus, and Web of Science were queried for comparative studies evaluating AS in patients with SRMs (PROSPERO: CRD42024530299). The primary outcomes were overall (OS) and cancer-specific survival (CSS). A random-effects model was used for quantitative analysis. KEY FINDINGS AND LIMITATIONS: We identified eight eligible studies (three prospective, four retrospective, and one study based on Surveillance, Epidemiology and End Results [SEER] data) involving 4947 patients. Pooling of data with the SEER data set revealed significantly higher OS rates for patients receiving surgical interventions (hazard ratio [HR] 0.73; p = 0.007), especially partial nephrectomy (PN; HR 0.62; p < 0.001). However, in a sensitivity analysis excluding the SEER data set there was no significant difference in OS between AS and surgical interventions overall (HR 0.84; p = 0.3), but the PN subgroup had longer OS than the AS group (HR 0.6; p = 0.002). Only the study based on the SEER data set showed a significant difference in CSS. The main limitations include selection bias in retrospective studies, and classification of interventions in the SEER database study. CONCLUSIONS AND CLINICAL IMPLICATIONS: Patients treated with AS had similar OS to those who underwent surgery or ablation, although caution is needed in interpreting the data owing to the potential for selection bias and variability in AS protocols. Our review reinforces the need for personalized shared decision-making to identify patients with SRMs who are most likely to benefit from AS. PATIENT SUMMARY: For well-selected patients with a small kidney mass suspicious for cancer, active surveillance seems to be a safe alternative to surgery, with similar overall survival. However, the evidence is still limited and more studies are needed to help in identifying the best candidates for active surveillance. Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.