PD51-04 ACTIVE SURVEILLANCE FOR LOCALIZED RENAL MASSES: GROWTH RATES AND OUTCOMES IN PATIENTS WITH MASSES ≥4 CM

Abstract

You have accessJournal of UrologyKidney Cancer: Localized: Active Surveillance1 Apr 2018PD51-04 ACTIVE SURVEILLANCE FOR LOCALIZED RENAL MASSES: GROWTH RATES AND OUTCOMES IN PATIENTS WITH MASSES ≥4 CM Andrew McIntosh, Tianyu Lee, Richard Greenberg, David YT Chen, Rosalia Viterbo, Marc Smaldone, Alexander Kutikov, and Robert Uzzo Andrew McIntoshAndrew McIntosh More articles by this author , Tianyu LeeTianyu Lee More articles by this author , Richard GreenbergRichard Greenberg More articles by this author , David YT ChenDavid YT Chen More articles by this author , Rosalia ViterboRosalia Viterbo More articles by this author , Marc SmaldoneMarc Smaldone More articles by this author , Alexander KutikovAlexander Kutikov More articles by this author , and Robert UzzoRobert Uzzo More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2344AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Active surveillance (AS) has gained acceptance as a management strategy for localized renal masses. Conventional wisdom and recent guidelines suggest that AS may be ideal for patients with masses <4 cm. Questions remain regarding safety and clinical outcomes in patients on AS with ≥T1b masses. We reviewed our large single center experience with AS in patients with masses ≥4 cm. METHODS From 2000-2016, we identified 540 patients with 651 lesions managed with AS from our prospectively maintained kidney cancer database. Two subsets of patients with masses ≥4 cm (Large renal mass - LRM) (n=84) and <4 cm (mall renal mass - SRM) (n=456) were indexed. Linear growth rates (LGR) were evaluated with linear regression. Chi-square and Wilcoxon tests were used to assess relationships between tumor size and demographic/clinical factors. Kaplan-Meier estimates and log-rank tests were used to compare both the overall survival and time to delayed intervention between the groups. RESULTS Median follow-up for the entire AS cohort was 62.6 mo (IQR 34.9-90.2 mo). Median LGR was 1.6 mm/yr (IQR 0-4 mm/yr). The groups had similar median ages at presentation (69 vs 70 yrs, p=0.35). Median maximum tumor diameter (MTD) at presentation was 20.3 mm (IQR 15-27 mm) vs. 54.3 mm (IQR 43-64 mm) (p<0.0001). Median LGR was faster in the LRM group (16.5 vs 22.8 mm/yr, p=0.48) and median time to delayed intervention (DI) was less in the LRM group (30.6 vs 25.4 mo, p=0.13) but neither difference was statistically significant. Rates of DI at 5 years (Figure 1) (37.1% [95% CI 32-42.9%] vs. 35.8% [95% CI 23.8-51.5%], p=0.75) and OS at 5 years (Figure 2) (90.4% [95% CI 86.8-93.1%] vs 87.3% [95% CI 76-93.6%], p=0.27) were not significantly different between the SRM and LRM groups, respectively. Five patients (1.1%) in the SRM group and zero patients in the LRM group died from renal cell carcinoma (RCC) (p=0.61). CONCLUSIONS At 5-years, AS ± DI appears safe in well selected patients with localized renal masses ≥4 cm. Metastasis and death from RCC were rare events and freedom from DI and OS were similar between LRM and SRM groups. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e976-e977 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Andrew McIntosh More articles by this author Tianyu Lee More articles by this author Richard Greenberg More articles by this author David YT Chen More articles by this author Rosalia Viterbo More articles by this author Marc Smaldone More articles by this author Alexander Kutikov More articles by this author Robert Uzzo More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...