MP41-02 TUMOR SIZE IS ASSOCIATED WITH GROWTH KINETICS IN SMALL RENAL MASSES ON ACTIVE SURVEILLANCE

Abstract

You have accessJournal of UrologyCME1 Apr 2023MP41-02 TUMOR SIZE IS ASSOCIATED WITH GROWTH KINETICS IN SMALL RENAL MASSES ON ACTIVE SURVEILLANCE Maximilian Pallauf, Michael Rezaee, Roy Elias, Tina Wlajnitz, Sean A. Fletcher, Khalid Alkhatib, Peter Chang, Andrew A. Wagner, James M. McKiernan, Mohammad E. Allaf, Phillip M. Pierorazio, and Nirmish Singla Maximilian PallaufMaximilian Pallauf More articles by this author , Michael RezaeeMichael Rezaee More articles by this author , Roy EliasRoy Elias More articles by this author , Tina WlajnitzTina Wlajnitz More articles by this author , Sean A. FletcherSean A. Fletcher More articles by this author , Khalid AlkhatibKhalid Alkhatib More articles by this author , Peter ChangPeter Chang More articles by this author , Andrew A. WagnerAndrew A. Wagner More articles by this author , James M. McKiernanJames M. McKiernan More articles by this author , Mohammad E. AllafMohammad E. Allaf More articles by this author , Phillip M. PierorazioPhillip M. Pierorazio More articles by this author , and Nirmish SinglaNirmish Singla More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003279.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Active surveillance (AS) is an accepted treatment strategy for small renal masses (SRM) <4 cm. Intervention is recommended for SRMs exceeding growth rates (GR) of 0.5 cm/year. We sought to identify clinical factors predictive of GR >0.5 cm/year for SRM on AS. METHODS: We queried the prospective, multi-institutional Delayed Intervention and Surveillance for SRM (DISSRM) registry for patients enrolled in AS. We tabulated clinical factors, including age, sex, and tumor size, and quantified GRs of SRMs between study enrollment and delayed intervention, metastasis, death, or last follow-up, whichever occurred first. GR was defined by the change in tumor size over time between the first and latest imaging. We defined growth progression as a GR in excess of 0.5 cm/year. We used recurrent-event multivariable Cox-regression modeling to test the associations between clinical factors and growth progression; age and tumor size were handled as time-varying covariates. Tumor size was tested as a continuous and dichotomized variable based on a cutoff of 2 cm, endorsed by the AUA guidelines. To account for GR variability within the first few months of AS, we excluded follow-up visits earlier than six months. RESULTS: Between 2009 and 2022, 591 patients were initially enrolled onto AS within the DISSRM registry, of whom 332 were on AS for at least six months. The median follow-up time of patients who continued AS was 4.0 years (IQR 2.6-6.1). Sixty-six patients (20%) exhibited growth progression, but no patient developed metastatic disease. Fifty patients (15%) underwent delayed intervention. While age and sex were not associated with growth progression, tumor size was an independent predictor of growth progression on multivariable analysis (HR 2.61 (95% CI 2.16-3.15), p<0.001). On dichotomization of tumor size, we found that tumors ≥ 2 cm were significantly associated with growth progression compared to those <2 cm (HR 4.29 (95% CI 2.43-7.61), p<0.001) (Figure). The mean GR for tumors ≥ 2 cm was 0.21 cm/year (±0.31) vs. 0.06 cm/year (±0.26) for those <2 cm. CONCLUSIONS: Larger tumor size is independently associated with clinically meaningful growth progression (GR >0.5 cm/year) for SRMs on AS. Identifying clinical factors predictive of growth kinetics for SRMs is important to guide patient counseling by informing personalized strategies of AS versus intervention. Source of Funding: This publication was made possible by the Johns Hopkins Institute for Clinical and Translational Research (ICTR) which is funded in part by Grant Number UL1 TR003098 from the National Center for Advancing Translational Sciences (NCATS) a component of the National Institutes of Health (NIH), and NIH Roadmap for Medical Research. Its contents are solely the responsibility of the authors and do not necessarily represent the official view of the Johns Hopkins ICTR, NCATS or NIH.Pallauf M gratefully acknowledges the support of the Paracelsus Medical University Research and Innovation Fund (2022-FIRE-004-Pallauf). © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e554 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Maximilian Pallauf More articles by this author Michael Rezaee More articles by this author Roy Elias More articles by this author Tina Wlajnitz More articles by this author Sean A. Fletcher More articles by this author Khalid Alkhatib More articles by this author Peter Chang More articles by this author Andrew A. Wagner More articles by this author James M. McKiernan More articles by this author Mohammad E. Allaf More articles by this author Phillip M. Pierorazio More articles by this author Nirmish Singla More articles by this author Expand All Advertisement PDF downloadLoading ...