Authors' objectives: To summarize the evidence on the effectiveness and comparative effectiveness of strategies for evaluating and treating patients with a renal mass suspicious for renal cell carcinoma, including use of composite models for predicting malignancy at initial diagnosis, use of percutaneous renal sampling (by fine needle aspiration or core biopsy) to establish a diagnosis, and comparative efficacy of radical nephrectomy, partial nephrectomy, thermal ablation, and active surveillance.

Authors' recommendations: No composite model reliably predicts malignancy, although tumor size and male sex are highly associated with malignancy. Percutaneous renal mass sampling with core biopsy is a low risk and sensitive procedure, but is associated with a notable non-diagnostic rate (14 percent). Most patients with non-diagnostic biopsies who proceed to surgery are found to have malignancy. Cancer-specific survival was comparable across all management strategies, with differences in overall survival that are explained by competing risks of death. Thermal ablation has the highest local recurrence rate and may require multiple treatments to achieve similar oncologic efficacy as radical or partial nephrectomy. However, thermal ablation has the most favorable perioperative outcomes and harms. Thermal ablation and partial nephrectomy offer improved renal functional outcomes over radical nephrectomy in the long run. Comparative data are lacking on active surveillance. Therefore, selection of a management strategy warrants a conversation between patient and physician to discuss the outcome profile for each strategy based on similar cancer-specific survival but different overall survival (competing health risks), renal functional outcomes, perioperative outcomes, and postoperative harms.

Project Status: Completed

Year Published: 2016

URL for published report: https://www.effectivehealthcare.ahrq.gov/ehc/products/601/2185/renal-cancer-report-160224.pdf

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: United States

Organisation Name: Agency for Healthcare Research and Quality

Contact Address: Center for Outcomes and Evidence Technology Assessment Program, 540 Gaither Road, Rockville, MD 20850, USA. Tel: +1 301 427 1610; Fax: +1 301 427 1639;

Contact Name: martin.erlichman@ahrq.hhs.gov

Contact Email: martin.erlichman@ahrq.hhs.gov

Copyright: Agency for Healthcare Research and Quality (AHRQ)