Comparison of renal functional outcomes of active surveillance and partial nephrectomy in the management of oncocytoma



To compare functional outcomes of partial nephrectomy (PN) and active surveillance (AS) in oncocytoma.


Multicenter retrospective analysis of patients with oncocytoma managed with PN or AS (biopsy-confirmed). Primary outcome development of de novo chronic kidney disease (CKD) (eGFR < 60 mL/min/1.73m2). Cox regression Multivariable analysis (MVA) was carried out for predictors of de novo CKD. Linear regression was carried out for factors associated with increasing deltaGFR. Kaplan–Meier Analysis (KMA) was performed to analyze 5-year CKD-free survival.


295 patients were analyzed (224 PN/71 AS, median follow-up 37.4 months). No differences were noted for clinical tumor size (AS 2.6 vs. PN 2.9 cm, p = 0.108), and baseline eGFR (AS 79.6 vs. PN 77, p = 0.9670). Median change in tumor diameter for AS was 0.42 cm. Compared to PN, AS had deltaGFR (−15.3 vs. −6.4 mL/min/1.73m2, p < 0.001) and de novo CKD (28.2% vs. 12.1%, p = 0.002). AS patients who developed CKD had higher RENAL score (p = 0.005) and lower baseline eGFR (73 vs. 91.2 mL/min/1.73m2, p < 0.001) than AS patients who did not. MVA demonstrated increasing age (OR = 1.03, p = 0.025), tumor size (HR = 1.26, p = 0.032) and AS (HR = 4.91, p < 0.001) to be predictive for de novo CKD. Linear regression demonstrated AS was associated with larger decrease in deltaGFR (B = −0.219, p < 0.001). KMA revealed 5-year CKD survival was higher in PN (87%) vs. AS (62%, p < 0.001).


AS was associated with greater functional decline than PN in oncocytoma. PN may be considered to optimalize renal functional preservation in select circumstances. Further investigation into mechanisms of functional decline in oncocytoma is requisite.

This is a preview of subscription content, log in to check access.

Fig. 1


  1. 1.

    Kane CJ, Mallin K, Ritchey J et al (2008) Renal cell cancer state migration: analysis of the National Cancer Data Base. Cancer 113:78–83

    Article  Google Scholar 

  2. 2.

    Johnson DC, Vukina J, Smith AB et al (2015) Preoperatively misclassified, surgically removed benign renal masses: a systematic review of surgical series and United States population level burden estimate. J Urol 193:30–35

    Article  Google Scholar 

  3. 3.

    Wu A (2017) Oncocytic renal neoplasms on resections and core biopsies: our approach to this challenging differential diagnosis. Arch Pathol Lab Med 141:1336–1341

    CAS  Article  Google Scholar 

  4. 4.

    Choudhary S, Rajesh A, Mayer NJ et al (2009) Renal oncocytoma: CT features cannot reliably distinguish oncocytoma from other renal neoplasms. Clin Radiol 64:517–522

    CAS  Article  Google Scholar 

  5. 5.

    Campbell S, Uzzo RG, Allaf ME et al (2017) Renal mass and localized renal cancer: aua guideline. J Urol 198:520–529

    Article  Google Scholar 

  6. 6.

    Mir MC, Capitanio U, Bertolo R et al (2018) Role of active surveillance for localized small renal masses. Eur Urol Oncol 1:177–187

    Article  Google Scholar 

  7. 7.

    Hamilton ZA, Capitanio U, Lane BR et al (2019) Should partial nephrectomy be considered "elective” in patients with stage 2 chronic kidney disease? A comparative analysis of functional and survival outcomes after radical and partial nephrectomy. World J Urol 37:2429–2437

    Article  Google Scholar 

  8. 8.

    Lane BR, Samplaski MK, Herts BR et al (2008) Renal mass biopsy—a renaissance? J Urol 179:20–27

    Article  Google Scholar 

  9. 9.

    Ljungberg B, Albiges L, Abu-Ghanem Y et al (2019) European Association of Urology Guidelines on Renal Cell Carcinoma: the 2019 update. Eur Urol 75:799–810

    Article  Google Scholar 

  10. 10.

    Donat SM, Diaz M, Bischoff JT et al (2013) Follow-up for clinically localized renal neoplasms: AUA guideline. J Urol 190:407–416

    Article  Google Scholar 

  11. 11.

    Kutikov A, Uzzo RG (2009) The R.E.N.A.L nephrometry score: a comprehensive standardized system for quantifying renal tumor size, location, and depth. J Urol 182:844–853

    Article  Google Scholar 

  12. 12.

    Levey AS, Stevens LA, Schmid CH et al (2009) A new equation to estimate glomerular filtration rate. Ann Intern Med 150:604–612

    Article  Google Scholar 

  13. 13.

    Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213

    Article  Google Scholar 

  14. 14.

    Patel HD, Pierorazio PM, Johnson MH et al (2017) Renal functional outcomes after surgery, ablation, and active surveillance of localized renal tumors: a systematic review and meta-analysis. Clin J Am Soc Nephrol 12:1057–1069

    Article  Google Scholar 

  15. 15.

    Lane BR, Abouassaly R, Gao T et al (2010) Active treatment of localized renal tumors may not impact overall survival in patients aged 75 years or older. Cancer 116:3119–3126

    Article  Google Scholar 

  16. 16.

    Danzig MR, Ghandour RA, Chang P et al (2015) Active surveillance is superior to radical nephrectomy and equivalent to partial nephrectomy for preserving renal function in patients with small renal masses: results from the DISSRM registry. J Urol 194:903–909

    Article  Google Scholar 

  17. 17.

    Castaneda CV, Danzig MR, Finkelstein JM et al (2015) The natural history of renal functional decline in patients undergoing surveillance in the DISSRM registry. Urol Oncol 33:166.e17–20

    Article  Google Scholar 

  18. 18.

    Macintosh AG, Ristau BT, Ruth K et al (2018) Active surveillance for localized renal mass: tumor growth, delayed intervention rates, and >5-yr clinical outcomes. Eur Urol 74:157–164

    Article  Google Scholar 

  19. 19.

    Ball MW, An JY, Gomella PT et al (2020) Growth rates of genetically defined renal tumors: implications for active surveillance and intervention. J Clin Oncol 38:1146–1153

    Google Scholar 

  20. 20.

    Richard PO, Jewett MA, Bhatt JR et al (2016) Active surveillance for renal neoplasms with oncocytic features is safe. J Urol 195:581–586

    Article  Google Scholar 

  21. 21.

    Neuzillet Y, Lechevallier E, Andre M et al (2005) Follow-up for renal oncocytoma diagnosed by percutaneous tumor biopsy. Urology 66:1181–1185

    Article  Google Scholar 

  22. 22.

    Parker PA, Alba F, Fellman B et al (2013) Illness uncertainty and quality of life of patients with small renal tumors undergoing watchful waiting: a 2-year prospective study. Eur Urol 63:1122–1127

    Article  Google Scholar 

  23. 23.

    Alam R, Patel HD, Osumah T et al (2019) Comparative effectiveness of management options for patients with small renal masses: a prospective cohort study. BJU Int 123:42–50

    Article  Google Scholar 

  24. 24.

    Ouzaid I, Autorino R, Fatica R et al (2014) Active surveillance for renal angiomyolipoma: outcomes and factors predictive of delayed intervention. BJU Int 114:412-417

    Google Scholar 

  25. 25.

    Marconi L, Dabestani S, Lam TB et al (2016) Systematic review and meta-analysis of diagnostic accuracy of percutaneous renal tumour biopsy. Eur Urol 69:660–673

    Article  Google Scholar 

  26. 26.

    Cacciamani GE, Medina LG, Gill T et al (2018) Impact of surgical factors on robotic partial nephrectomy outcomes: comprehensive systematic review and meta-analysis. J Urol 200:258–274

    Article  Google Scholar 

  27. 27.

    Bertolo R, Garisto J, Dagenais J et al (2019) cT1a renal masses less than 2 versus 2 cm or greater managed by robotic partial nephrectomy: a propensity score matched comparison of perioperative outcomes. J Urol 201:56–61

    Article  Google Scholar 

  28. 28.

    Kim M, Choi WS, Jeong CW et al (2015) Differences in peritumoral pseudocapsule characteristics according to clinicopathological factors in clinical T1a renal tumors. Int J Clin Exp Pathol 8:11323–11331

    PubMed  PubMed Central  Google Scholar 

  29. 29.

    Demirović A, Cesarec S, Marušić Z et al (2014) TGF-β1 expression in chromophobe renal cell carcinoma and renal oncocytoma. Eur J Histochem 58:2265

    Article  Google Scholar 

  30. 30.

    Yu R, Mao J, Yang Y et al (2015) Protective effects of calcitriol on diabetic nephropathy are mediated by down regulation of TGF-β1 and CIP4 in diabetic nephropathy rat. Int J Clin Exp Pathol 8:3503–3512

    CAS  PubMed  PubMed Central  Google Scholar 

Download references


The project was supported by Stephen Weissman Kidney Cancer Research Fund.

Author information




M: data collection, data analysis, manuscript writing/editing. L: project development, manuscript writing/editing. Capitanio project development, manuscript writing/editing. M: protocol development, data collection, manuscript writing/editing. B: data collection, data management. N: data collection, data management. L: data management, manuscript editing. E: data management, manuscript editing. G: data management, data analysis. P: data management, protocol development. B: data collection, data management. D: data collection, data management. K: data collection, data management. M: data collection, data management. W: data collection, data management, protocol development. M: project development, manuscript writing/editing. D: project development, manuscript writing/editing.

Corresponding author

Correspondence to Ithaar H. Derweesh.

Ethics declarations

Availability of data and material

Not available.

Consent to participate

Not applicable given study design and covered by IRB approval.

Consent for publication:

Not applicable.

Code availability

Not available.

Conflict of interest

None of the authors have any conflicts of interest to declare.

Ethics approval

IRB approval at all institutions.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Meagher, M.F., Lane, B.R., Capitanio, U. et al. Comparison of renal functional outcomes of active surveillance and partial nephrectomy in the management of oncocytoma. World J Urol (2020).

Download citation


  • Active surveillance
  • Chronic kidney disease
  • Glomerular filtration rate
  • Kidney neoplasm
  • Oncocytoma
  • Partial nephrectomy