AUA 2018: Active Surveillance of T1a Renal Masses: Results from National Cancer Database

San Francisco, CA USA ( Dave Jiang, MD, currently a second year resident at Oregon Health and Science University, presented data comparing results on the active surveillance (AS) and other intervention of T1a renal masses based on the National Cancer Database (NCDB). He focused on determining the contemporary use and results of AS in SRMs in the United States. He introduced T1a kidney cancer as a small renal mass (SRMs, ≤ 4 cm) in which 20% are benign. Active surveillance (AS) has been a management strategy since 2010 because such tumors have a low rate of metastases in the first 3 years (<5%).

The author’s study compared NCDB data from 2010-2015 of cT1aN0M0 renal masses to find clinical and socioeconomic factors predictive of AS recipients by assessing the trends in the rate of AS over time. The active surveillance patients (N=2,560) was 3% of the total SRMs from 2010-2015 (N=81,221). Furthermore, the received treatment patient group was divided into four categories: total nephrectomy (25%), partial nephrectomy (56%), ablative treatment (10%), and unknown treatment (9%).

In this podium presentation, Dr. Jiang acknowledged the limitation of data due to AS not being recognized as a treatment modality until 2010 by the NCDB. The data also lacked the accurate capture of true comorbidity of patients. In addition, the NCDB was created by participation, allowing for selection bias due to the cancer centers.

Dr. Jiang concluded that the strongest clinical predictors for AS was advanced age (≥ 75 years old) and tumor size (≤ 2.5cm). Even so, there were other significant non-clinical factors that also determined treatment such as: race, sex, insurance, facility volume, and academic centers. Both the multivariate and univariate analysis confirmed that these factors played a role in determining the treatment. He also explained that AS was presently very underutilized for SRMs and many older patients with very small renal masses (up to 88%) received some type of treatment.

Presented by: Dave Jiang, MD

Written by: Song Park, Department of Urology, University of California-Irvine at the 2018 AUA Annual Meeting - May 18 - 21, 2018 – San Francisco, CA USA