AUA 2018: Use of Surveillance vs Active Treatment for Renal Masses ≤7 Cm: Results from the MUSIC KIDNEY Regional Collaborative

San Francisco, CA ( Active surveillance has now become an established first-line therapeutic option for cT1a renal masses. However, uptake of active surveillance (AS) has not been universal. Quality control measures have been instituted internationally to help further evaluate its utilization and efficacy.

The MUSIC initiative, a unique regional quality improvement collaborative, is an effective way to analyze the patterns of care that are in place across multiple practices. It assesses practice patterns across multiple practice types across Michigan to provide a better cross-section of urologic practice. For the kidney project, 8 Michigan practices were analyzed from September 2017 onward. Due to the relatively recent initiation of the study, all patients were entered into the system at 120 days (4 months), so follow-up was the same across the board.

In the first seven months, 316 patients with newly diagnosed renal masses ≤7cm (cT1) were evaluated at the eight sites. Seven diverse pilot practices contributed data from visits to 16 physicians. 

Of these patients, 139 (44%) initially chose definitive treatment and 123 (39%) pursued active surveillance (AS). The remaining 52 patients had a renal biopsy to help make their treatment decision - after the biopsy, 25 (48%) chose AS, 27 (52%) chose definitive treatment.

  • Of cT1a, 55% chose AS
  • Of cT1b, 13% chose AS
Patients choosing AS versus definitive treatment demonstrated a significant difference in age (68 vs. 63 years) and tumor size (median: 2.3 vs. 3.4 cm). Comorbidity, gender, race, insurance status, BMI, and GFR were not significantly associated with treatment decision (p>0.05 for each). AS use among pilot practices varied from 0-61% - which indicates that physician guidance is an important determinant in treatment decision.

As more knowledge and safety of AS is gained, and as more physicians become comfortable with it, hopefully, its utilization will continue to increase. It is encouraging to see the use of renal biopsy (approximately 15% of patients). However, further work is needed to help ensure AS is offered as a first line therapy.

Dr. Coleman (MSKCC) asked the presenter and senior authors re: the intent of observation period – calling all these patients AS when the intent was not curative is inappropriate. Observation in a non-operative candidate is not considered AS – as is the case in prostate cancer. Yet, that information (intent) is not gleaned from the study. 

Presented by: Brian Lane, MD, Ph.D., FACS, Spectrum Health; Michigan State University College of Human Medicine; Betz Family Endowed Chair for Cancer Research
Co-Authors: Alon Weizer, Tae Kim, Ji Qi, Ann Arbor, MI, Sanjeev Kaul, Royal Oak, MI, Edward Schervish, Troy, MI, Benjamin Stockton, St. Joseph, MI, Craig Rogers, Detroit, MI, for the Michigan Urological Surgery Improvement Collaborative, Ann Arbor, MI (the Michigan Urological Surgery Improvement Collaborative [MUSIC])

Written by: Thenappan Chandrasekar, MD, Clinical Fellow, University of Toronto, @tchandra_uromd at the 2018 AUA Annual Meeting - May 18 - 21, 2018 – San Francisco, CA USA