Patients with small renal masses (SRMs) have several management options available to them, and a recent study presented at the 2022 International Kidney Cancer Symposium: North America in Austin, Texas, provides clues to how they choose among them,

The study revealed that patient health and tumor characteristics, information processing, and decision-making behavior influences whether they opt for active surveillance (AS), surgery, or ablation.

Approximately 30% of SRMs of 4 cm or less are benign and only 20% contain aggressive disease, Kathryn Hacker Gessner, MD, of the Lineberger Comprehensive Cancer Center at the University of North Carolina at Chapel Hill, and colleagues pointed out in a poster presentation. These SRMs have low metastasis rates.

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In GRADE-SRM (Genomic Risk Assessment and Decisional Evaluation for Small Renal Masses), a comparative hybrid trial investigating genomics and the decision-making experience, the investigators evaluated clinical, tumor, and decision-making factors driving treatment selection among 245 patients with newly diagnosed clinical T1 renal masses. Patients had a mean age of 62.2 years; 61% were male and 31% were non-White.

Of the 245 patients, 59% chose surgery, 34% chose AS, and only 5% opted for ablation, Dr Gessner’s team reported in a poster presentation. Treatments decisions varied by age, sex, mass size, performance status, nephrometry score, and type of mass (cystic vs solid), according to the investigators.

Decisions were directly related to information-seeking behavior, decisional conflict, and cancer worry. Patients choosing AS perceived cancer and metastasis risks to be lower compared with those opting for surgery and ablation. Renal mass biopsy was also associated with choosing surgery or ablation, Dr Gessner and colleagues reported.

“These relationships highlight the opportunity for communication frameworks and prognostic biomarkers to further improve the patient decision-making experience,” the authors concluded.


Gessner KH, Feinberg A, Myers S et al. Treatment decisions among patients newly diagnosed with clinical T1 renal masses. Presented at: 2022 International Kidney Cancer Symposium: North America, November 4-5, Austin, Texas. Abstract 28.