This was a single-centre, retrospective study of the outcomes of 36 elderly, comorbid patients undergoing active surveillance (AS) for large (cTlb or higher) renal tumours with a mean initial diameter of 7.1 cm (range: 4-13.7 cm) and monitored with regular radiologic and clinical follow-up over a mean period of 36 mo (range: 53-90 mo). The mean age was 73.8 yr (range: 53-90 yr), and 53% of patients had advanced comorbidity with a Charlson index >3. Twelve patients (33%) underwent renal biopsy, with pathologic confirmation of renal cell carcinoma (RCC) in 11. The mean growth rate was 0.57 cm/yr (range: 0-5.9). AS failed in five patients (13.9%) due to metastatic progression in two (5.6%) and rapid tumour growth in three (8.3%). There was no cancer-specific mortality over follow-up, although four patients (11.1%) died from other causes.
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