ATLANTA—New findings suggest a need to proceed with caution when deciding whether to use nonsurgical management (NSM) for patients with renal cell carcinoma, according to a report presented at the American Urological Association 2012 annual meeting.
In a study comparing 1,007 patients managed with NSM, 5,935 who underwent partial nephectomy (PN), and 13,721 who underwent radical nephrectomy (RN), investigators led by Maxine Sun, PhD, of the University of Montreal Medical Center, found that nonsurgical management was associated with a significantly higher five-year cancer-specific mortality rate compared with those who underwent PN and RN (22% vs. 4.6% and 4.2%, respectively), even after accounting for differences in patient comorbidities and other factors and mortality from other causes.
These findings are not meant to discourage use of NSM, but to highlight a need to weigh more carefully whether NSM is an appropriate approach, Dr. Sun said.
The study also points to a need to improve patient selection and uniform follow-up strategies, she said. Otherwise, clinicians could wind up following high-grade tumors that are probably better managed surgically.