AUA 2017: Active Surveillance for Cystic Renal Masses with 5 or More Years of Follow-Up
Among 2574 in the Fox Chase Cancer Center prospectively maintained database, the authors identified 601 patients on AS, 196 of whom had cystic renal masses. The primary outcome of the study was that individuals subsequently underwent delayed intervention for their cystic renal mass. Those with cystic renal masses who were enrolled in AS were predominantly male (64.3%), had a median age of 64 years, and showed a mean estimated tumor volume of 39 cm3. The median follow-up for the cohort was 59.7 months, during which 48 patients (24%) underwent delayed intervention at a median time of 16.7 months, with the majority (64%) done within 2 years of diagnosis. Furthermore, individuals with cystic renal masses were less likely (33.9% vs. 23.3%, P < .016) to proceed to treatment when compared with patients with solid renal masses. The mean change in estimated tumor volume was 5.8 cm3/yr, which was slower when contrasted with solid masses (5.8 vs. 11.4 cm3/yr, P < .04). Importantly, 95% of patients were alive at 60 months of follow-up, and only one of them developed distant metastasis. A possible limitation of the study was that renal biopsy rates and pathologic diagnosis for those patients undergoing renal biopsy were not provided.
The authors concluded that AS with or without delayed intervention is a successful strategy in well-selected patients with localized cystic renal masses and that most people who are slated to receive delayed intervention will do so within the first 2 years on AS. The results presented were important when considering the potential for overtreatment of these typically indolent renal lesions. Similar results suggested a benign course for cystic renal masses that would be presented later during the American Urological Association 2017 Annual Meeting.1
Presented By: Andrew McIntosh, MD, Fox Chase Cancer Center, Philadelphia, PA, USA
Co-Authors: Pranav Parikh, MD; Anthony Tokarski, MD; Eric Ross, MD; David Chen, MD; Richard Greenberg, MD; Alexander Kutikov, MD; Marc Smaldone, MD; Rosalia Viterbo, MD; Robert Uzzo, MD
Written By: Zachary Klaassen, MD, Urologic Oncology Fellow, University of Toronto, Princess Margaret Cancer Centre
Twitter: @zklaassen_md
at the 2017 AUA Annual Meeting - May 12 - 16, 2017 – Boston, Massachusetts, USA
Reference:
1. Chandrasekar T, Ahmad AE, Fadaak K, et al. PD11-06 Cystic Renal Masses: Is the Bosniak Classification System an Adequate Predictor of Survival? J Urol. 2017;197(4):e208.