SAN DIEGO, CA USA (UroToday.com) - Active surveillance for small renal masses has increasingly made headlines and received prominent attention at this year’s Genitourinary Cancer Symposium and the American Urologic Association annual meetings.
Dr. William Huang and colleagues used the SEER cancer registry data linked with Medicare claims to identify patients ≥ 66-years-old with a diagnosis of kidney cancer < 4 cm in size, between 2000 and 2004.
Cohorts were separated into those treated with surgery and those treated non-surgically for at least 6 months from the initial diagnosis. Outcome metrics were death from any cause, death due to RCC, and cardiovascular (CV) events. Propensity-score methods were used to control for potential confounders. Of 7 148 patients, 1 584 (22%) were managed non-surgically, 3 623 (65%) underwent radical nephrectomy (RN), and 1 941 (35%) nephron-sparing surgery (NSS). With a median follow-up of 59 months, 1 689 (24%) had at least one CV event and 1 536 (21%) died, with 191 deaths (3%) attributed to RCC. Cause-specific survival (CSS) did not differ by treatment approach (HR 0.67; CI 0.44-1.04). When controlling for disease characteristics, surveillance was associated with a significantly lower risk of death from any cause (HR 0.63; CI 0.54-0.74) and of experiencing a CV event (HR 0.51; CI 0.44-0.60). Death from any cause was highest in the RN group (HR 1.75; CI 1.49-2.05), followed by PN group (1.34; CI 1.12-1.61), as compared to the non-surgical management group.
Authors conclude that in older patients, surveillance does not appear to adversely affect CSS, while surgery, especially RN, may be associated with CV complications and death from other causes. While these results further support evidence for active surveillance in the elderly and infirm, they must be interpreted with caution as patients on true active surveillance may differ from those undergoing non-surgical management in SEER – Medicare dataset.
Presented by William C. Huang, Laura C. Pinhiero, William T. Lowrance, Paul Russo, and Elena B. Elkin at the American Urological Association (AUA) Annual Meeting - May 4 - 8, 2013 - San Diego Convention Center - San Diego, California USA
Reported for UroToday.com by Serge Ginzburg, MD
