Presentation Authors: Mohit Gupta*, Hiten Patel, Ridwan Alam, Alice Semerjian, Michael Gorin, Michael Johnson, Baltimore, MD, Peter Chang, Andrew Wagner, Boston, MA, James McKiernan, New York, NY, Mohamed Allaf, Phillip Pierorazio, Baltimore, MD
Introduction: A number of patients who elect active surveillance of their small renal masses (â‰¤4 cm) subsequently pursue delayed intervention. The indications, timing, and rates of delayed intervention have not been well determined prospectively.
Methods: Data from DISSRM (Delayed Intervention and Surveillance for Small Renal Masses), a prospective, multi-institutional registry was utilized to evaluate factors associated with delayed intervention between 2009-2018.
Results: Of 371 patients enrolled in active surveillance, 46(12.4%) pursued delayed intervention. Patients who pursued delayed intervention spent a median 12 months on surveillance (IQR5.5-23.6), had better functional status (p < 0.01), and had greater median growth rate versus those who remained on surveillance (0.38 vs 0.05,p < 0.001). Indications for intervention included growth rate >0.5cm/year for 23 (50%) patients, patient preference for 22 (47.8%) patients, and qualification for renal transplant in 1(2.2%) patient. Thirty-two patients (69.6%) underwent nephron-sparing surgery, 5(10.9%) underwent radical nephrectomy, and 9(19.6%) underwent percutaneous cryoablation. Renal mass biopsy was utilized in 37(11.4%) and 15(32.7%) patients in the AS and delayed intervention arms, respectively, (p=0.04). No patients experienced metastatic progression or died of kidney cancer.
Conclusions: As nearly 50% of patients pursue delayed intervention secondary to anxiety in the absence of clinical progression, comprehensive counseling is essential to determine if patients are suitable for a surveillance protocol. Active surveillance remains a safe initial management option for many patients but may not be a durable strategy for patients who are acceptable surgical candidates with an extended life expectancy. Delayed intervention does not compromise oncologic outcomes or limit treatment options.