Small renal masses: Where do we stand? An updated analysis of trends and outcomes from the SEER database (2000-2021).

Objectives: To provide an updated analysis of trends and outcomes for these approaches using data from the SEER database (2000-2021).

Methods: Patients diagnosed with localized T1a renal cell carcinoma (RCC) were identified from the SEER database. Management strategies were categorized as PN, RN, AT, or non-surgical management (NSM), including AS. Descriptive statistics assessed patient demographics and tumor characteristics. Logistic regression models identified predictors of NSM, adjusting for age, race, tumor grade, histology, and socioeconomic factors. Kaplan-Meier survival analysis and Cox proportional hazards regression evaluated associations between management type and 5-year overall survival.

Results: RN usage declined sharply from ∼75% in 2000 to ∼14% in 2021, while PN steadily increased, surpassing RN around 2017 and reaching ∼50% by 2021. Notably, younger patients (<60 years) demonstrated a more rapid shift toward partial nephrectomy over time, whereas the oldest patients (>75 years) showed a slower uptake of partial nephrectomy and a higher ongoing utilization of non-surgical management. AT and NSM showed gradual adoption, peaking at ∼10% and ∼15% to 20%, respectively, by 2021. PN was associated with the best overall survival, followed by RN and AT, while NSM had the poorest outcomes. Predictors of NSM included advanced age (>75 years, OR = 3.54) and black race (OR = 1.63).

Conclusion: PN has become the most widely used management for SRMs, aligned with AUA and EAU guidelines. AS remains a viable and guideline-recommended option for select patients with SRMs <2 cm. The variable use of AT and NSM, coupled with the poorer prognosis of NSM, underscores the importance of individualized patient selection and close follow-up to ensure optimal outcomes.