PD52-07 MANAGEMENT AND LONG-TERM OUTCOME OF COMPLICATED RENAL CYSTS

Abstract

You have accessJournal of UrologyKidney Cancer: Epidemiology & Evaluation/Staging/Surveillance II (PD52)1 Sep 2021PD52-07 MANAGEMENT AND LONG-TERM OUTCOME OF COMPLICATED RENAL CYSTS Lassi Luomala, Juhana Rautiola, Petrus Järvinen, Tuomas Mirtti, and Harry Nisén Lassi LuomalaLassi Luomala More articles by this author , Juhana RautiolaJuhana Rautiola More articles by this author , Petrus JärvinenPetrus Järvinen More articles by this author , Tuomas MirttiTuomas Mirtti More articles by this author , and Harry NisénHarry Nisén More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002079.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We evaluated pathological and oncological outcomes of patients with Bosniak IIF, III and IV cystic renal masses in a single center series. METHODS: We identified 533 patients with Bosniak IIF-IV cystic renal masses (Bosniak IIF n=287, Bosniak III n=140, Bosniak IV n=106) counselled during 2006-2017. In this study, initial surgery (IS) referred to surgical treatment of cystic masses within 5 months of diagnosis and delayed surgery (DS) referred to surgical treatment during active surveillance (AS) due to any cause. We compared oncological and pathological outcomes between patients in IS and AS groups stratified by Bosniak classification. The primary endpoints were progression free survival (PFS) and cancer specific survival (CSS) and secondary endpoints were surgical pathology and radiographic upgrading of Bosniak category. RESULTS: AS was delivered to 99,7% in Bosniak IIF, 60,7% in Bosniak III and 19,8% in Bosniak IV category, respectively. Surgery (IS or DS) was performed to 185 patients (34,7%). In the whole cohort, the median follow up was 64 months (IQR 51-91) for AS and 77 months (IQR 49-107) for IS. Metastatic progression developed in 10 patients - one (0,3%) in Bosniak IIF, four (2,8%) in Bosniak III and five (4,7%) in Bosniak IV. Median time to progression was 46 months (range 2-118). PFS rate was 98,0% for the whole cohort. Four patients died of RCC during follow up and CSS rate was 99.2% for the whole cohort. There was no statistically significant difference in PFS and CSS rates between AS and IS groups. Malignancy rates of the operated (IS or DS) patients were 41,7% in Bosniak IIF, 78,1% in Bosniak III and 88% in Bosniak IV. Radiographic upgrading was recorded in 18 (6,3%) cases with Bosniak IIF and 6 (4,2%) cases with Bosniak III. Malignancy rate of operated upgraded cystic masses was 58,3% (7/12). CONCLUSIONS: In patients with complicated renal cysts, metastatic progression and death due cancer are rare, but not negligible. With clinical selection of patients, active surveillance (AS) did not increase the risk of metastatic spread or cancer-specific mortality of patients with Bosniak IIF and III renal cysts. Our study confirms AS as the primary choice for patients with Bosniak IIF and surgery for patients with Bosniak IV. Our results support the growing evidence of safety and efficacy of AS in patients with Bosniak III. Prolonging active surveillance times to 10 years is worth considering because of occasional very slow progression, at least in Bosniak III category, where prospective randomized controlled trials are warranted. Source of Funding: Suomen Lääketieteen Säätiö, Finnish Association of Urology, Helsinki university hospital © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e913-e913 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Lassi Luomala More articles by this author Juhana Rautiola More articles by this author Petrus Järvinen More articles by this author Tuomas Mirtti More articles by this author Harry Nisén More articles by this author Expand All Advertisement Loading ...