A comparative analysis of fear of cancer recurrence in patients with small renal masses: Active surveillance versus cryoablation.

BACKGROUND AND PURPOSE: The aim of this study was to evaluate and compare the fear of cancer recurrence (FCR) in patients diagnosed with a small renal mass (SRM) and managed with either active surveillance (AS) or minimal invasive renal cryoablation (CA). PATIENTS/MATERIAL AND METHODS: A total of 398 patients with SRMs (263 AS and 135 CA patients) were retrospectively identified across three institutions and invited to complete the Fear of Cancer Recurrence-Short Form (FCRI-SF) questionnaire. RESULTS: No statistically significant differences in FCRI-SF score were observed between the AS (mean = 10.9, standard deviation [SD] = 6.9) and CA (mean = 10.2, SD = 7.2) (p = 0.559) patients, with the mean scores of both groups being below the suggested clinically significant cut-off of 16. A total of 25% of AS and 28% of CA patients reported sub-clinical or clinical levels of FCR (FCRI-SF score > 16). Within the AS group, a weak negative association between FCR severity and age was observed (r = -0.23, p = 0.006), and a statistically significant difference in FCRI-SF score between patients aged more or less than 73 years (p = 0.009). INTERPRETATION: FCR levels were comparable between AS and CA patients, suggesting that treatment decisions should prioritise clinical factors. Up to 28% of AS and CA patients report clinically significant FCR, highlighting the importance of considering the possibility of FCR, especially in younger patients.

Active Surveillance of Small Renal Masses in a Large Danish Cohort: Assessing Proficiency in Patient Selection.

Small renal masses (SRMs) are often benign or early-stage cancers with low metastatic potential. The risk of overtreating SRMs is a particular concern in elderly or comorbid patients, for whom the risks associated with active surveillance (AS) are lower than the risks of surgical management. The aim is to systematically analyse a large cohort of AS patients to provide valuable insights into patient selection and outcomes concerning delayed intervention (DI) and AS termination. We retrospectively analysed data from 563 AS patients across three institutions from 2012 to 2023. Patients were classified into three groups: those currently in AS (n=283), those who underwent DI (n=75), and those who terminated AS (n=205). DI patients were younger, and had larger initial tumour size and higher growth rates (GRs) than AS patients. A significant number of patients terminated their AS, mainly due to comorbidities and death from non-kidney cancer causes, suggesting unsuitability for initial AS enrolment. AS appears to be a safe initial management strategy for SRMs, with an overall low GR and only one patient developing metastasis. The patient selection for AS appears inconsistent, highlighting the need for improved criteria to identify AS candidates, especially considering comorbidities and the possibility of subsequent active treatment in the event of progression.

Impact of ischemia time during partial nephrectomy on short- and long-term renal function.

OBJECTIVE: Partial nephrectomy is the gold standard treatment in small renal tumours. During partial nephrectomy, the renal artery is clamped which creates transient ischemia. This can damage nephrons and may affect kidney function immediately postoperatively and on long-term.In the present study, we investigated the effect of ischemia time during partial nephrectomy with regards to affection of renal function immediately post-operatively and 1-year post-surgery. MATERIALS AND METHOD: A retrospective cohort study including 124 patients who underwent partial nephrectomy at a single regional hospital in the period from 2018 to 2020 was conducted. RESULTS: We divided patients into subgroups based on the ischemia time: [0-8], [9-13] and [14-29] minutes. The mean value for kidney function was an eGFR (mL/min) of 73.9 before and 66.8 at a 12-month post-surgery. We found no significant correlation between ischemia time and renal function. Noticeably, none of the patients had ischemia time greater than 30 min. CONCLUSION: In this cohort, the duration of ischemia time was not associated with differences in renal affection neither on short term nor long term parameters if the ischemia time was kept below 30 min.

Survival of patients with kidney cancer in central and northern Denmark, 1998-2009.

OBJECTIVE: For decades, kidney cancer patients in Denmark have had lower survival than patients in the other Scandinavian countries. Our aim was to study possible changes in survival of patients with kidney cancer after implementation of two national Danish cancer plans. STUDY DESIGN AND SETTING: From 1998 through 2009 we included all patients (N = 2659) with an incident diagnosis of kidney cancer in two Danish regions (population 1.8 million). Data were retrieved from the Danish National Registry of Patients. We computed survival after 1, 3, and 5 years, stratified by age, and estimated mortality rate ratios (MRRs) using Cox regression to assess changes over time, controlling for age and gender. We lacked data on stage distribution. Among patients who had a nephrectomy we also computed 30-day mortality and 30-day MRRs. RESULTS: During the study period, we identified 2659 patients with kidney cancer. The annual number of patients increased from 583 in the period 1998-2000 to 853 in the period 2007-2009. The median age at diagnosis was 69 years throughout the study period. The overall 1-year survival improved from 56% (1998-2000) to 63% (2007-2009), corresponding to an adjusted MRR of 0.78 (95% confidence interval [CI] 0.66-0.93). We predicted the 3-year survival to increase from 40% to 51% and the 5-year survival to increase from 33% to 42%, corresponding to predicted MRRs of 0.76 (95% CI 0.66-0.87) and 0.77 (95% CI 0.68-0.89), respectively. Survival increased in all age groups (15-59 years, 60-74 years, 75+ years) and in both genders, except for men below 60 years, for whom the 1-year survival declined from 76% to 69%. The 30-day mortality after nephrectomy declined from 4% to 2% during the study period. CONCLUSION: We observed an improvement in the survival and relative mortality in kidney cancer patients, although not in men younger than 60 years.