PD58-10 OUTCOMES OF ACTIVE SURVEILLANCE FOR YOUNG AND HEALTHY PATIENTS WITH SMALL RENAL MASSES

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You have accessJournal of UrologyKidney Cancer: Epidemiology & Evaluation/Staging/Surveillance III (PD58)1 May 2024PD58-10 OUTCOMES OF ACTIVE SURVEILLANCE FOR YOUNG AND HEALTHY PATIENTS WITH SMALL RENAL MASSES Muammer Altok, Arun Menon, Ahmed Aly, Tashionna White, Gaybrielle James, Bo Xu, Michael Petroziello, Charles Roche, and Eric Kauffman Muammer AltokMuammer Altok , Arun MenonArun Menon , Ahmed AlyAhmed Aly , Tashionna WhiteTashionna White , Gaybrielle JamesGaybrielle James , Bo XuBo Xu , Michael PetrozielloMichael Petroziello , Charles RocheCharles Roche , and Eric KauffmanEric Kauffman View All Author Informationhttps://doi.org/10.1097/01.JU.0001008868.74763.2c.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Reported outcomes for active surveillance (AS) in patients with small renal masses (SRM) are heavily biased towards older and unhealthier patients. The safety, tolerability, and rates of delayed intervention (DI) for AS in younger and healthier SRM patients remain largely unexplored. Here we report outcomes at a single center for young/healthy SRM patients with estimated life expectancy (LE) >20 years managed with AS +/- DI. METHODS: A retrospective review was performed for a young/healthy subset of patients managed with a prospectively defined AS pathway by a single urologist at a National Comprehensive Cancer Network center. From January 2013 - May 2022, all patients with non-hereditary SRM were offered AS regardless of age/health as long as predefined progression criteria for intervention (PCI) were absent at presentation. DI was recommended during AS only upon new PCI development. PCI was defined prospectively as any SRM-related symptoms, unfavorable biopsy histology, cT3a stage, or either of the following without benign neoplastic biopsy histology: longest tumor diameter (LTD) >4 cm; growth rate >5 mm/year for LTD ≤3 cm or >3 mm/year for LTD >3 cm. Young/healthy patients in the AS cohort with LE >20 years were retrospectively identified using LE estimations from age- and sex-adjusted social security indices. Patients with Charlson Comorbidity Index (CCI) >2 or BMI >40 were excluded from analyses. 3- and 5-year rates of PCI- and DI-freedom were determined. RESULTS: 101 of 102 (99%) SRM patients with LE >20 years, CCI ≤2 and BMI ≤40 did not have PCI at presentation, and all 101 patients underwent AS. Median (IQR) age, CCI, and tumor size were 55 (47-60) years, 0 (0-2), and 2 (1.5-2.7) cm. With median follow-up of 47 months, 28/101 (28%) AS patients developed PCI, of whom 22/28 (79%) underwent DI, and 1 (1%) AS patient crossed over to DI without PCI. 3- and 5-year PCI-free rates were 71% and 61%, and 3- and 5-year DI-free rates were 78% and 68%, respectively. No patient developed metastasis. CONCLUSIONS: To our knowledge, this study describes the largest cohort and longest follow-up for young and healthy patients undergoing AS. AS using specific predefined PCI thresholds is well tolerated and allows most SRM patients with >20 years LE to safely avoid treatment over 5 years. Long-term DI rates and oncologic safety require further study. Download PPT Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e1219 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Muammer Altok More articles by this author Arun Menon More articles by this author Ahmed Aly More articles by this author Tashionna White More articles by this author Gaybrielle James More articles by this author Bo Xu More articles by this author Michael Petroziello More articles by this author Charles Roche More articles by this author Eric Kauffman More articles by this author Expand All Advertisement PDF downloadLoading ...

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