MP55-18 COMPARATIVE EFFICACY OF EXTIRPATIVE SURGERY, THERMAL ABLATION, AND ACTIVE SURVEILLANCE FOR PATIENTS WITH SMALL RENAL MASSES: RESULTS FROM THE DISSRM REGISTRY

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You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy III1 Apr 2017MP55-18 COMPARATIVE EFFICACY OF EXTIRPATIVE SURGERY, THERMAL ABLATION, AND ACTIVE SURVEILLANCE FOR PATIENTS WITH SMALL RENAL MASSES: RESULTS FROM THE DISSRM REGISTRY Ridwan Alam, Hiten D. Patel, Alice Semerjian, Mark F. Riffon, Bruce J. Trock, Peter Chang, Andrew A. Wagner, James M. McKiernan, Mohamad E. Allaf, and Phillip M. Pierorazio Ridwan AlamRidwan Alam More articles by this author , Hiten D. PatelHiten D. Patel More articles by this author , Alice SemerjianAlice Semerjian More articles by this author , Mark F. RiffonMark F. Riffon More articles by this author , Bruce J. TrockBruce J. Trock 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 , Mohamad E. AllafMohamad E. Allaf More articles by this author , and Phillip M. PierorazioPhillip M. Pierorazio More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1711AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Little prospective data exists evaluating comparative oncologic, renal function, and quality of life outcomes for patients with small renal masses (cT1a, ≤4.0 cm). We sought to elucidate these outcomes in the prospectively-maintained Delayed Intervention and Surveillance for Small Renal Masses (DISSRM) registry. METHODS Patients were enrolled following a choice of primary intervention or active surveillance (AS). Patients who received intervention were further defined by the type of treatment: partial nephrectomy (PN), radical nephrectomy (RN), or ablation. Cancer-specific and overall survival rates were estimated with the Kaplan-Meier method and compared using the log-rank test. Glomerular filtration rate (GFR) was compared across groups at enrollment, 3, 6, and 12 months, and last available measurement. The Short Form 12 (SF-12) questionnaire was administered at enrollment, 6 and 12 months, and every year thereafter. The Physical Component Summary (PCS) and Mental Component Summary (MCS) of the SF-12 were evaluated among groups and over time using ANOVA and linear regression mixed modeling. RESULTS Of the 615 enrolled patients, 317 originally chose AS. A total of 256 patients underwent PN, 47 RN, and 36 ablation. PN patients were younger (P < 0.001) and had fewer comorbidities (P < 0.001) than AS patients. Cancer-specific survival at 7 years did not differ among groups (P = 0.5), but overall survival was lower in the AS group (65.9%, P = 0.01) compared to PN (91.9%), RN (89.6%), and ablation (82.9%). From 193 patients, median GFR at enrollment was similar at 71.3, 68.1, 55.5, and 69.5 mL/min/1.73 m2 in the PN, RN, ablation, and AS groups, respectively (P = 0.7); at a median follow-up time of 1.5 years, the median GFR was 69.3, 43.7, 55.7, and 68.0 mL/min/1.73 m2 across the respective groups (P = 0.2). From a total of 1,932 SF-12 questionnaires, PN patients reported significantly higher PCS scores compared to AS patients at enrollment and annually thereafter until year 5. Patients in AS demonstrated lower PCS scores over time (P = 0.01), but MCS was not meaningfully different among groups or across time. CONCLUSIONS Superior overall survival and PCS outcomes in PN patients compared to AS patients are attributable to more favorable health characteristics at baseline. However, kidney function at enrollment was not a factor in determining management and does not vary appreciably after intervention type. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e737-e738 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Ridwan Alam More articles by this author Hiten D. Patel More articles by this author Alice Semerjian More articles by this author Mark F. Riffon More articles by this author Bruce J. Trock 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 Mohamad E. Allaf More articles by this author Phillip M. Pierorazio More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...