PD17-04 EXPERIENCE WITH ACTIVE SURVEILLANCE (AS) IN PATIENTS WITH RENAL MASS >4CM: ASSESSMENT OF GROWTH KINETICS AND OUTCOMES

Abstract

You have accessJournal of UrologyKidney Cancer: Localized II1 Apr 2014PD17-04 EXPERIENCE WITH ACTIVE SURVEILLANCE (AS) IN PATIENTS WITH RENAL MASS >4CM: ASSESSMENT OF GROWTH KINETICS AND OUTCOMES Reza Mehrazin, Marc C. Smaldone, Alexander Kutikov, Jeffrey J. Tomaszewski, Tianyu Li, Timothy Ito, Philip Abbosh, Rosalia Viterbo, Richard E. Greenberg, David Y.T. Chen, and Robert G. Uzzo Reza MehrazinReza Mehrazin More articles by this author , Marc C. SmaldoneMarc C. Smaldone More articles by this author , Alexander KutikovAlexander Kutikov More articles by this author , Jeffrey J. TomaszewskiJeffrey J. Tomaszewski More articles by this author , Tianyu LiTianyu Li More articles by this author , Timothy ItoTimothy Ito More articles by this author , Philip AbboshPhilip Abbosh More articles by this author , Rosalia ViterboRosalia Viterbo More articles by this author , Richard E. GreenbergRichard E. Greenberg More articles by this author , David Y.T. ChenDavid Y.T. Chen More articles by this author , and Robert G. UzzoRobert G. Uzzo More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1511AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Introduction and Objectives Compared to T1a lesions, the natural history of untreated renal masses is >4cm is poorly understood. We sought to assess the growth kinetics and outcomes of cT1b cortical renal tumors managed with an initial period of active surveillance (AS), and compared these patients to those who underwent definitive intervention. Methods Our institutional, prospectively maintained, renal tumor database was reviewed to identify enhancing solid & cystic masses managed expectantly from 2000−2012. Clinically localized tumors >4.0 cm (≥T1b) that were radiographically followed for >6 months were included for analysis. Tumor size at presentation, annual linear tumor growth rate (LGR), Charlson comorbidity index (CCI), length of follow−up (FU), and clinical outcomes were compared between those who remained on AS or those who underwent delayed surgical intervention using ANOVA and Chi square tests. Adjusting for patient and tumor characteristics, logistic regressions were used to test for associations with progression to definitive surgical intervention. Results Of 457 patients managed with AS, 72 tumors >4cm in diameter (in 68 patients) were identified. 45 patients (66%) were managed solely with AS, while 23 (34%) progressed to intervention. For all lesions, the median tumor size at presentation was 4.9 cm, and the median LGR was 0.44 cm/year. 14.7% of masses demonstrated no growth over time. Comparing patients managed exclusively with AS and those progressing to definitive intervention, no differences were noted in median tumor size at presentation (4.9 vs. 4.6cm, p=0.82) or median CCI (3 vs. 2, p=0.6), while significant differences were seen with respect to median age at presentation (76 vs. 60 years, p=0.0002) and median LGR (0.37 vs. 0.68 cm/year, p=0.04). Following adjustment, younger patients (OR 0.91 [CI 0.86-0.97]) and tumors with faster LGR (OR 9.1 [CI 1.7-6.0]) were more likely to undergo delayed surgical intervention. With a mean FU period of 38.9 ± 24.0 months (range 6−105), 9 patients died (13%) from other cause and no patient progressed to metastatic disease. Conclusions Localized cT1b or larger renal masses show comparable growth rates to small tumors managed expectantly with low rates of progression to metastatic disease at short term follow up. An initial period of AS to determine tumor growth kinetics is a reasonable option in select patients with significant competing risks and limited life expectancy. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e541 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Reza Mehrazin More articles by this author Marc C. Smaldone More articles by this author Alexander Kutikov More articles by this author Jeffrey J. Tomaszewski More articles by this author Tianyu Li More articles by this author Timothy Ito More articles by this author Philip Abbosh More articles by this author Rosalia Viterbo More articles by this author Richard E. Greenberg More articles by this author David Y.T. Chen More articles by this author Robert G. Uzzo More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...