PD51-02 CONDITIONAL SURVIVAL AND LANDMARK ANALYSIS FOR PATIENTS WITH SMALL RENAL MASSES UNDERGOING ACTIVE SURVEILLANCE AT A TERTIARY CARE CENTER

Abstract

You have accessJournal of UrologyKidney Cancer: Localized: Active Surveillance1 Apr 2018PD51-02 CONDITIONAL SURVIVAL AND LANDMARK ANALYSIS FOR PATIENTS WITH SMALL RENAL MASSES UNDERGOING ACTIVE SURVEILLANCE AT A TERTIARY CARE CENTER Firas Petros, Aradhana Venkatesan, Diana Kaya, Chaan Ng, Bryan Fellman, Jose Karam, Christopher Wood, and Surena Matin Firas PetrosFiras Petros More articles by this author , Aradhana VenkatesanAradhana Venkatesan More articles by this author , Diana KayaDiana Kaya More articles by this author , Chaan NgChaan Ng More articles by this author , Bryan FellmanBryan Fellman More articles by this author , Jose KaramJose Karam More articles by this author , Christopher WoodChristopher Wood More articles by this author , and Surena MatinSurena Matin More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2342AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Conditional survival can provide guidance for patients once they have survived a period of time after diagnosis of their disease. We determine conditional survival for patients with small renal masses (SRM) undergoing active surveillance (AS). METHODS Patients were enrolled in a prospective AS registry at our institution between May 2005 and January 2016. Patients with localized SRM ≤4cm were included, with serial radiologic imaging available in-house for re-review. Overall survival (OS) was estimated using the Kaplan-Meier method and modeled via Cox proportional hazards models. The primary end points analyzed were the conditional probability of survival and tumor growth over time. Landmark analysis was used to evaluate survival outcomes beyond the 2-year mark after the initial scan. RESULTS A total of 272 patients were included in this analysis. Mean initial tumor size was 1.74 ± 0.77 cm and mean tumor size closest to the 2-year mark was 1.97 ± 0.83 cm. The likelihood of continued survival to 5 years improved after the 2-year landmark was reached. Patients with tumors <3cm who survived the first 2-years on AS had a 0.84-0.85 chance of surviving to 5 years, and if they survived 3 years, the probability of surviving to 5 years improved to 0.91. Multivariable Cox proportional hazards analysis of survival revealed eGFR, Charlson comorbidity index (CCI), and tumor size of 3-4cm were significantly predictive of OS both at baseline and at 2-year mark (all p < 0.05). Patients with a tumor size 3-4 cm were at a greater risk of non-RCC death (HR >3.5; p ≤ 0.001). A linear mixed effects model revealed slow tumor growth (beta: 0.12; p < 0.001) for tumors <3cm. Adjusted tumor size predictions disclosed parallel growth rates for SRM of <2cm and 2-2.99cm with insignificant difference in growth rates (p = 0.969), Figure. CONCLUSIONS Our study provides insight into the survival of patients with SRM on AS who have already survived a certain period of time. The conditional survival probability of patients with SRM <3cm on AS improved after the initial 2 years, suggesting a role for re-counseling for those who survive to the 2-year landmark. Patient factors (renal function and CCI) were significantly associated with survival at baseline and at the 2-year landmark. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e976 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Firas Petros More articles by this author Aradhana Venkatesan More articles by this author Diana Kaya More articles by this author Chaan Ng More articles by this author Bryan Fellman More articles by this author Jose Karam More articles by this author Christopher Wood More articles by this author Surena Matin More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...