Non-surgical management vs active treatment in T1a renal cell carcinoma: a population-based study.

Abstract

To compare overall and cancer-specific survival for clinical (c)T1aN0M0 renal cell carcinoma (RCC) in patients treated with non-surgical management (NSM: surveillance and watchful waiting) or active treatment (surgery and ablative treatments). In this nationwide real-world population-based cohort study, data on clinical, demographic, and socioeconomic factors as well as tumour characteristics and cause of death were retrieved from the Renal Cell Carcinoma Database Sweden (RCCBaSe) for 3989 patients diagnosed with cT1aN0M0 RCC, 2011-2020 and treated with either NSM or active treatment. Differences in survival between NSM and active treated patients were analysed using standard and competing-risks Cox regression models. In total, 3727 (93.4%) patients underwent active treatments, while 262 patients (6.6%) were treated with NSM. Patients in the NSM group were significantly older and had a higher comorbidity burden. During a median follow-up time of 4.1 years, all-cause mortality was significantly higher among the NSM (38.9%) than the actively treated (10.9%) patients (P < 0.001), as was cancer-specific mortality (13.0% vs 3.4%, P < 0.001). Larger tumours, older age, male sex, increased comorbidity, being unmarried or widowed, having lower disposable income, and having clear cell or papillary RCC compared with chromophobe RCC were all independently associated with poorer overall and cancer-specific survival. One of the limitations is that treatment allocation was not randomised. Non-surgical management of cT1aN0M0 RCC was associated with poorer survival compared with surgery/ablation and should be offered mainly for patients with limited life expectancy and indolent renal tumours.