The Natural History of Small Renal Masses

Study Overview
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Brief Summary
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There is a rising incidence of incidentally detected small renal tumours due to improved imaging techniques. Traditionally, patients diagnosed with these small renal masses undergo surgery and therefore there is limited data about the natural history of these tumours. Several small series have reported that most of these small masses grow slowly and might not require early intervention and that only some masses grow rapidly requiring immediate surgery. Presently, the investigators have not been able to identify prospectively which masses are going to grow slowly. The investigators plan to use computed tomography (CT) and Magnetic Resonance Imaging (MRI) parameters, microsatellite analysis and tissue analysis to determine which masses will behave more aggressively. Additionally, the observations on the natural history of small renal masses need to be validated with a multicentric and systematically followed cohort.

Detailed Description
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Hypothesis Since most renal cell carcinomas (RCC's) that are now detected by imaging as small renal masses, grow slowly and remain asymptomatic for years, we hypothesize that: Small RCC's that are destined to metastasize do so early or after they reach a larger size Delayed surgical treatment of asymptomatic, incidentally detected, small RCC's WILL NOT have a significant impact on overall survival The majority of small RCC's MAY NOT need to be treated. RCC's that are destined to progress can be identified by abnormal perfusion patterns on imaging and by their cellular and genomic characteristics on needle biopsy.

Official Title
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Role of Active Surveillance and Identification of Prognostic Factors for Progression in Early Stage Renal Cell Carcinoma

Conditions
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Patients With Newly Diagnosed Small Renal Masses(<4cm)

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Asymptomatic T1a (< 4.0 cm) renal mass and unfit for surgery due to advanced age or co-morbidity, OR Asymptomatic T1a (< 4.0 cm) and refusal of surgery No evidence of metastatic disease (N0M0) Preparedness to comply with a close follow-up protocol Informed consent Exclusion Criteria: Life expectancy < 2 years Already being followed for a small renal mass for more than 12 months Concurrent systemic therapy for other malignancies Known hereditary renal cancer syndromes

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Tumour progression: | i) calculated tumour volume doubles (100% increase) within any one-year period, and/or ii) the maximum tumour diameter reaches 4 cm., and/or iii) patients develop symptoms considered to be possibly due to their renal tumour and/or iv) patients develop metastases | 4 times year 1, 2 times year 2 and 3, yearly thereafter | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Time to Tumour Progression | Time to tumour progression will be measured from the date of diagnosis to the date of progression or, if progression has not occurred, until the date of last follow-up. | 4 times year 1, 2 times year 2 and 3, yearly thereafter | 
| Growth rate | Defined by volume (cm3 ) measured over time (years). Tumour bi-dimensional diameter will be recorded and reported to allow comparison with the literature to date. Tumour volume will be calculated from follow-up images using the formula for ellipsoid volume: 0.5326 x X x Y x Z. | 4 times year 1, 2 times year 2 and 3, yearly thereafter | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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small renal mass, active surveillance, kidney mass, kidney tumour