scholarly journals Optimizing the management of patients with small renal masses in a Canadian context: A Markov decision-analysis model

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Kristen McAlpine ◽  
Maneesh Sud ◽  
Antonio Finelli ◽  
Girish S. Kulkarni
Keyword(s):  
Decision Analysis ◽  
Active Surveillance ◽  
Management Strategy ◽  
Renal Mass ◽  
Index Patient ◽  
Decision Analysis Model ◽  
Initial Management ◽  
Markov Decision ◽  
Renal Mass Biopsy ◽  
Probability Of Cancer

Introduction: The management of patients with a small renal mass (SRM) varies significantly. The objective of this study was to determine which initial management strategy resulted in the greatest quality-adjusted life months (QALM) for an index patient with a SRM. Methods: A Markov decision analysis was used to determine the effect of 1) treating patients with a partial nephrectomy (PN); 2) active surveillance; and 3) renal mass biopsy on QALM over a 10-year horizon. All relevant health states were modelled. Biopsy sensitivity and specificity were modelled assuming an 80% prevalence of cancer using procedural pathology as the gold standard. Health state utilities were obtained from the Tufts Medical Centre Cost-Effective Analysis Registry. Deterministic sensitivity analyses were used to test key assumptions. Results: Over a 10-year time horizon for a 70-year-old male with a 2 cm SRM, the biopsy strategy resulted in 38.07 QALM, whereas treating all patients with PN resulted in 37.69 QALM and active surveillance in 36.25 QALM. The model was most sensitive to the probability that a patient would remain alive at baseline. Biopsy was the preferred strategy when sensitivity was greater than 77%. As the underlying probability of cancer increased, the threshold of renal mass biopsy sensitivity to still favor biopsy increased. Conclusions: Renal mass biopsy is the preferred initial management strategy for an index patient with a SRM to optimize QALM. When the probability of cancer is high, centers should aim for a sensitivity of at least 77% in order to consider a biopsy first strategy.

Predictors of Delayed Intervention for Patients on Active Surveillance for Small Renal Masses: Does Renal Mass Biopsy Influence Our Decision?

Urology ◽  
2016 ◽  
Vol 98 ◽  
pp. 88-96 ◽  
Author(s):  
Sapan N. Ambani ◽  
Todd M. Morgan ◽  
Jeffrey S. Montgomery ◽  
Adam J. Gadzinski ◽  
Bruce L. Jacobs ◽  
...  
Keyword(s):  
Active Surveillance ◽  
Renal Mass ◽  
Small Renal Masses ◽  
Renal Masses ◽  
Renal Mass Biopsy ◽  
Delayed Intervention

scholarly journals Active surveillance for nodular lymphocyte-predominant Hodgkin lymphoma

Blood ◽  
2019 ◽  
Vol 133 (20) ◽  
pp. 2121-2129 ◽  
Author(s):  
Sven Borchmann ◽  
Erel Joffe ◽  
Craig H. Moskowitz ◽  
Andrew D. Zelenetz ◽  
Ariela Noy ◽  
...  
Keyword(s):  
Overall Survival ◽  
Hodgkin Lymphoma ◽  
Active Surveillance ◽  
Management Strategy ◽  
Progression Free Survival ◽  
Cancer Center ◽  
Initial Management ◽  
Free Survival ◽  
Radiotherapy Alone

Abstract Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is a rare subtype of lymphoma that, like other Hodgkin lymphomas, has historically been treated aggressively. However, in most cases, NLPHL has an indolent course, which raises the question of to what extent these patients require aggressive upfront treatment. We describe the management and outcomes of consecutive NLPHL patients diagnosed at Memorial Sloan Kettering Cancer Center (MSK), with a focus on evaluating active surveillance. All patients aged 16 years or older diagnosed and followed at MSK between 1974 and 2016 were included. Treatment outcomes were compared between management with active surveillance and other strategies. We identified 163 consecutive patients who were treated with radiotherapy alone (46%), active surveillance (23%), chemotherapy (16%), combined modality (12%), or rituximab monotherapy (4%). Median follow-up was 69 months. Five-year progression-free survival (PFS), second PFS (PFS2), and overall survival (OS) estimates were 85% (95% confidence interval [CI], 78-90), 97% (95% CI, 92-99), and 99% (95% CI, 95-100), respectively. Only 1 of 7 deaths was lymphoma related. Patients managed with active surveillance had slightly shorter PFS than those receiving any active treatment, with 5-year PFS of 77% (95% CI, 56-89) vs 87% (95% CI, 79-92; P = .017). This difference did not translate into better PFS2 or OS. Only 10 patients managed with active surveillance (27%) eventually required treatment, after a median of 61 months, and none died. NLPHL has an excellent prognosis. Within the limitations of a retrospective analysis, active surveillance is a viable initial management strategy for selected NLPHL patients.

scholarly journals Current Management of Small Renal Masses, Including Patient Selection, Renal Tumor Biopsy, Active Surveillance, and Thermal Ablation

2018 ◽  
Vol 36 (36) ◽  
pp. 3591-3600 ◽  
Author(s):  
Alejandro Sanchez ◽  
Adam S. Feldman ◽  
A. Ari Hakimi
Keyword(s):  
Active Surveillance ◽  
Thermal Ablation ◽  
Renal Mass ◽  
Tumor Biology ◽  
Treatment Selection ◽  
Patient Treatment ◽  
Small Renal Masses ◽  
Full Spectrum ◽  
Renal Masses ◽  
Renal Mass Biopsy

Renal cancer represents 2% to 3% of all cancers, and its incidence is rising. The increased use of ultrasonography and cross-sectional imaging has resulted in the clinical dilemma of incidentally detected small renal masses (SRMs). SRMs represent a heterogeneous group of tumors that span the full spectrum of metastatic potential, including benign, indolent, and more aggressive tumors. Currently, no composite model or biomarker exists that accurately predicts the diagnosis of kidney cancer before treatment selection, and the use of renal mass biopsy remains controversial. The management of SRMs has changed dramatically over the last two decades as our understanding of tumor biology and competing risks of mortality in this population has improved. In this review, we critically assess published consensus guidelines and recent literature on the diagnosis and management of SRMs, with a focus on patient treatment selection and use of renal mass biopsy, active surveillance, and thermal ablation. Finally, we highlight important opportunities for leveraging recent research discoveries to identify patients with SRMs at high risk for renal cell carcinoma–related mortality and minimize overtreatment and patient morbidity.

Natural History of Renal Angiomyolipoma (AML): Most Patients with Large AMLs >4 cm Can Be Offered Active Surveillance as an Initial Management Strategy

2016 ◽  
Vol 70 (1) ◽  
pp. 85-90 ◽  
Author(s):  
Jaimin R. Bhatt ◽  
Patrick O. Richard ◽  
Nicole S. Kim ◽  
Antonio Finelli ◽  
Karthikeyan Manickavachagam ◽  
...  
Keyword(s):  
Natural History ◽  
Active Surveillance ◽  
Management Strategy ◽  
Renal Angiomyolipoma ◽  
Initial Management ◽  
History Of
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