For early-stage kidney cancer patients who may be at risk for worsening kidney disease, personalized treatment plans may extend life expectancy, according to new research published online Jan. 15 in Radiology.
Partial nephrectomy, a surgical procedure in which the tumor and part of the kidney are removed, can treat kidney tumors discovered at early states. However, some patients, and especially those with chronic kidney disease, are advised to completely avoid the procedure.
"There may be clear-cut risks with an operation in these patients," lead author Stella K. Kang, MD, assistant professor of radiology and population health at NYU Langone Health in New York, said in a prepared statement. "Patients may have significant heart disease or other comorbidities, or a limited life expectancy for some other reason."
Although undergoing active surveillance of small, slow growing renal tumors through periodic CT scans can be a viable option for these patients, there is a high risk of underutilization because not many decision support tools or standard guidelines exist.
For the study, Kang and colleagues developed a computer-based simulation to assess the impact of different treatment approaches in patients with small renal kidney tumors. The model also accounted for the severity of kidney disease, competing risks of mortality and other factors.
Based on one million simulations, the researchers found partial nephrectomy yielded the longest life expectancy in patients of all ages with normal renal function. Patient with chronic kidney disease, however, benefited most from personalized strategies like surveillance over routine nephrectomy which extended life expectancy.
In simulated subgroups with moderate chronic kidney disease, personalized treatment decisions extended life expectancy by more than two years compared with a standard surgical approach, according to the researchers.
Additionally, the model determined using MRI to predict papillary renal cell carcinoma could help encourage chronic kidney disease patients to use active surveillance.
Results showed information from the model provided guidance on the benefits and risks of active surveillance and helped identify the right treatment for patients. Overall, the researchers hope the model will bring more value to the clinical-decision making process.
"There is probably a larger proportion of patients with small renal tumors who merit a fuller discussion of options than is currently recognized," Kang said. "While the model does not prescribe one specific treatment, it does provide a set of estimates so that patients and providers can get more information on the viable options."