SUO 2017: Determinants Of Active Surveillance In Patients With Small Renal Masses

Washington, DC ( Introduction: Active surveillance (AS) has been increasingly recognized as a viable management strategy for patients with small renal masses (SRM), that affords the delay or avoidance of definitive treatment. However, little is known about national utilization trends for AS, or the factors that influence initial expectant management.

Methods: The authors identified patients with clinical T1a renal masses within the National Cancer Database (NCDB) between 2010 to 2013. Patients were excluded based on the following criteria: metastatic or locally advanced disease, unknown management, or those who were offered but refused treatment outside of surveillance. Patients were dichotomized according to receipt of AS versus definitive treatment. Determinants of AS versus definitive treatment were examined among patients with SRMs using multivariable logistic regression models.

Results: A total of 30,873 patients who satisfied the inclusion criteria were identified. Of the total cohort, 829 (2.7%) individuals received initial management with AS, while 30,044 (97.3%) received definitive treatment. Treatment modality received included: partial nephrectomy in 16,266 (52.7%); radical nephrectomy in 6,005 (19.5%), cryo-ablation in 3,305 (10.7%), thermal ablation in 1,059 (3.4%), and other definitive therapy in 3,409 (11.0%). On multivariable analysis, increasing patient age (OR: 1.09, 95% CI: 1.08- 1.10, p<0.0001), smaller tumor size (OR: 0.957, 95% CI: 0.949-0.965, p<0.0001), treatment at an academic center vs. community center (OR: 1.98, 95% CI: 1.70-2.30, p<0.0001), and African American vs. Caucasian race (OR: 1.65, 95% CI:1.36- 1.99, p<0.0001) were significantly associated with increased use of AS as opposed to definitive treatment.

Conclusion: Clinical and facility-level differences in the utilization of AS in patients with T1a renal masses was observed. Additional research is warranted to better understand the forces underlying initial management decisions for patients with SRMs.

Presented by: Kevin Anh Nguyen, , New Haven, CT, USA

Written by: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre, @GoldbergHanan, at the 18th Annual Meeting of the Society of Urologic Oncology, November 29-December 1, 2017 – Washington, DC