PD59-05 ACTIVE SURVEILLANCE FOR RENAL MASSES WITH > 5 YEARS OF FOLLOW-UP: TUMOR GROWTH, DELAYED INTERVENTION RATES, AND CLINICAL OUTCOMES

Although surgical excision is the standard of therapy for small renal masses (SRMs), there is a growing recognition of active surveillance as an option in select patients who are poor surgical candidates or who have shorter life expectancy. A number of patients on expectant management, however, subsequently advance to definitive therapy. In this study, we systematically reviewed the literature and performed a pooled analysis of active surveillance series to evaluate the rate and indications for definitive treatment after initiating a period of active surveillance. Fourteen clinical series (1245 patients; 1364 lesions) met our selection criteria. Mean lesion size at presentation was 2.30 ± 0.40 cm with a mean follow-up of 33.6 ± 16.9 months. Collectively, 34.0% of patients underwent delayed intervention, which ranged in individual series from 3.6% to 70.3%. Of patients undergoing delayed intervention, the average time on active surveillance prior to definitive treatment was 27.8 ± 10.6 months. A pooled analysis revealed that 41.0% of patients underwent therapy secondary to tumor growth rate and 51.9% secondary to patient or physician preference in the absence of clinical progression. Overall, 1.1% of all patients progressed to metastatic disease during the average follow-up period. Thus, active surveillance may be an appropriate option for carefully selected patients with SRMs. However, delayed treatment is pursued in a significant percentage of patients within 3 years. Prospective registries and clinical trials with standardized indications for delayed intervention are needed to establish true rates of disease progressions and recommendations for delayed intervention.

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Growth kinetics and outcomes of cT1b renal masses under active surveillance.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.4_suppl.440 ◽

2014 ◽

Vol 32 (4_suppl) ◽

pp. 440-440

Author(s):

Reza Mehrazin ◽

Marc C. Smaldone ◽

Alexander Kutikov ◽

Jeffrey J. Tomaszewski ◽

Tianyu Li ◽

...

Keyword(s):

Growth Rate ◽

Tumor Growth ◽

Metastatic Disease ◽

Growth Kinetics ◽

Tumor Size ◽

Renal Tumors ◽

Tumor Growth Rate ◽

Renal Masses ◽

Delayed Intervention

440 Background: The natural history of untreated T1b renal masses is poorly understood. We assessed the growth kinetics and outcomes of ≥cT1b cortical renal tumors which continue to remain on radiographic AS compared to those who underwent definitive surgery after a period of AS. Methods: Prospectively maintained, renal tumor database was reviewed to identify enhancing solid and cystic masses managed expectantly from 2000-2012. cT1a masses, transitional cell carcinoma or those suspected for metastatic disease were excluded from analysis. Localized tumors > 4.0 cm (≥T1b) that were radiographically followed for > 6 months were included for analysis. Clinical and pathological records were reviewed to determine tumor growth rate and clinical outcomes in those remained on AS or those who underwent delayed intervention. Mean for tumor size on presentation, annual linear tumor growth rate (LGR), Charlson comorbidity index (CCI), and follow-up (FU) were calculated. Chi−square test & Logistic regression were used for uni- and multi-variable analyses. Results: Of 457 pts managed with AS, 67 cT1b tumors (in 63 patients) were identified. 43 pts (67%) were managed solely with AS, while 21 pts (33%) progressed to intervention. The median age at presentation pts managed with AS and intervention was 77 and 60 yrs respectively (p=0.0002), while no difference was observed in median CCI (3 vs. 2, p=0.6). No difference was observed in tumor size at presentation between pts managed with AS and those undergoing delayed intervention (5.9 vs. 5.4 cm, p=0.8). In contrast, the mean LGR significantly differed between pts managed expectantly and pts progressed to intervention (0.37 vs. 0.73 cm/yr; p=0.02). On MVA, age (OR=0.9,CI:0.8−0.98) and LGR (OR=11,CI:1.8−60) were significant predictors of surgical intervention. With a mean FU period of 38.9 ± 24.0 months (6−105), 9 pts died (14%) from other cause and no pt progressed to metastatic disease. Conclusions: Localized cT1b≥ renal masses show comparable growth rates to small tumors managed expectantly with low rates of progression to metastatic disease with short term follow up. An initial period of AS to determine tumor growth kinetics is a reasonable option in select pts with significant competing risks and limited life expectancy.

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Small Renal Masses Managed With Active Surveillance: Predictors of Tumor Growth Rate After Long-Term Follow-Up

Clinical Genitourinary Cancer ◽

10.1016/j.clgc.2014.08.006 ◽

2015 ◽

Vol 13 (2) ◽

pp. e87-e92 ◽

Cited By ~ 18

Author(s):

Riccardo Schiavina ◽

Marco Borghesi ◽

Hussam Dababneh ◽

Lorenzo Bianchi ◽

Barbara Longhi ◽

...

Keyword(s):

Growth Rate ◽

Tumor Growth ◽

Active Surveillance ◽

Tumor Growth Rate ◽

Small Renal Masses ◽

Renal Masses ◽

Long Term Follow Up

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Triggers for delayed intervention in patients with small renal masses undergoing active surveillance: a systematic review

Minerva Urologica e Nefrologica ◽

10.23736/s0393-2249.20.03870-9 ◽

2020 ◽

Vol 72 (4) ◽

Cited By ~ 1

Author(s):

Riccardo Campi ◽

Francesco Sessa ◽

Francesco Corti ◽

Diego M. Carrion ◽

Andrea Mari ◽

...

Keyword(s):

Systematic Review ◽

Active Surveillance ◽

Small Renal Masses ◽

Renal Masses ◽

Delayed Intervention

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Active Surveillance of Small Renal Masses: A Systematic Review

Kidney Cancer ◽

10.3233/kca-210114 ◽

2021 ◽

pp. 1-14

Author(s):

Elizabeth E. Ellis ◽

Edward Messing

Keyword(s):

Active Surveillance ◽

Meta Analysis ◽

Cost Effective ◽

Management Approach ◽

Small Renal Masses ◽

Cancer Specific Survival ◽

Renal Masses ◽

Review Current ◽

Delayed Intervention

Background: Our goal is to review current literature regarding active surveillance (AS) of small renal masses (SRMs) and identify trends in survival outcomes, factors that predict the need for further intervention, and quality of life (QOL). Methods: We performed a comprehensive literature search in PubMed and EMBASE and identified 194 articles. A narrative summary was performed in lieu of a meta-analysis due to the heterogeneity of selected studies. Results: Seventeen articles were chosen to be featured in this review. Growth rate (GR) was not an accurate predictor of malignancy, although it was the characteristic most commonly used to trigger delayed intervention (DI). The mean 5-year overall survival (OS) of all studies was 73.6% ±1.7% for AS groups. The combined cancer specific survival (CSS) for AS is 97.1% ±0.6% , compared to 98.6% ±0.4% for the primary intervention (PI) groups, (p = 0.038). Conclusions: Short and intermediate-term data demonstrate that AS with the option for DI is a management approach whose efficacy (in terms of CSS) approaches that of PI at 5 years, is cost effective, and prevents overtreatment, especially in patients with significant comorbidities.

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Intermediate-term outcomes from the DISSRM registry: A prospective analysis of active surveillance in patients with small renal masses.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.6_suppl.430 ◽

2017 ◽

Vol 35 (6_suppl) ◽

pp. 430-430 ◽

Cited By ~ 4

Author(s):

Ridwan Alam ◽

Hiten D. Patel ◽

Mark F. Riffon ◽

Bruce J. Trock ◽

Akachimere Uzosike ◽

...

Keyword(s):

Growth Rate ◽

Active Surveillance ◽

Progression Free Survival ◽

Tumor Diameter ◽

Small Renal Masses ◽

Cancer Specific Survival ◽

Renal Masses ◽

Free Survival ◽

Primary Intervention ◽

Delayed Intervention

430 Background: Active surveillance is an alternative to primary intervention aimed at reducing the overtreatment of small renal masses, defined as solid renal masses ≤4.0 cm (clinical stage T1a). Methods: Since 2009, the Delayed Intervention and Surveillance for Small Renal Masses (DISSRM) registry prospectively enrolled 615 patients with small renal masses who chose to undergo primary intervention or active surveillance. Intervention was recommended to patients for masses with an elevated growth rate (>0.5 cm/year) or increased tumor diameter (>4.0 cm). Primary outcomes were cancer-specific survival and overall survival; secondary outcomes included progression-free survival. Progression was strictly defined as growth rate >0.5 cm/year, greatest tumor diameter >4.0 cm, metastatic disease, or elective crossover. Outcomes were evaluated using Kaplan-Meier survival analysis and comparisons were performed using the log-rank test. Results: Of the 615 enrolled patients, 298 (48.5%) chose primary intervention and 317 (51.5%) chose active surveillance. From the active surveillance cohort, 45 (14.2%) patients underwent delayed intervention. Median follow-up time for the entire registry was 2.9 years, with 203 (33.0%) patients followed for 5 years or more. At baseline, patients who chose active surveillance were older (p < 0.001) and had higher comorbidity status (p < 0.001) than those who chose primary intervention. There was no difference in cancer-specific survival at 7 years between primary intervention and active surveillance (99.0% vs. 100%, respectively, p = 0.3). However, overall survival was higher in patients with primary intervention when compared to active surveillance at 5 years (93.0% vs. 80.2%, respectively) and 7 years (91.7% vs. 65.9%, respectively, p = 0.002). The 5-year and 7-year progression-free survival rate in the active surveillance cohort was 76.7% and 48.4%, respectively. Conclusions: In the intermediate-term, active surveillance appears to be as safe as primary intervention for carefully selected patients with small renal masses. As the registry matures, further studies will elucidate the effectiveness of active surveillance in the long-term. Clinical trial information: NCT02346435.

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