PD10-09 THE DISSRM SCORE: OBJECTIVE SCORING SYSTEM IDENTIFIES PATIENTS WITH SMALL RENAL MASSES MOST SUITABLE FOR ACTIVE SURVEILLANCE (2014)

You have accessJournal of UrologyKidney Cancer: Evaluation/Staging I1 Apr 2014PD10-09 THE DISSRM SCORE: OBJECTIVE SCORING SYSTEM IDENTIFIES PATIENTS WITH SMALL RENAL MASSES MOST SUITABLE FOR ACTIVE SURVEILLANCE Phillip Pierorazio, Deborah Kaye, Matthew Danzig, Rashed Ghandour, Peter Chang, Robert Hartman, Andrew Wagner, James McKiernan, and Mohamad Allaf Phillip PierorazioPhillip Pierorazio More articles by this author , Deborah KayeDeborah Kaye More articles by this author , Matthew DanzigMatthew Danzig More articles by this author , Rashed GhandourRashed Ghandour More articles by this author , Peter ChangPeter Chang More articles by this author , Robert HartmanRobert Hartman More articles by this author , Andrew WagnerAndrew Wagner More articles by this author , James McKiernanJames McKiernan More articles by this author , and Mohamad AllafMohamad Allaf More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.485AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES A growing body of retrospective literature has emerged regarding active surveillance (AS) for select patients with small renal masses (SRM). The prospective, multi-institutional Delayed Intervention and Surveillance for Small Renal Masses (DISSRM) Registry was opened January 1, 2009, enrolling patients with SRM ≤4.0 cm who chose intervention or AS. METHODS Patients were enrolled following consultation and choice of AS or intervention. Those electing AS followed an imaging protocol every 4-6 months for 2 years, then 6-12 months for 3 years. Objective criteria were developed from existing literature and refined based on experience with the registry. With a higher score indicating improved suitability for AS, points were assigned for age>65 (1), age>75 (2); ECOG>1 (2), greatest tumor diameter <3cm (1) or <2cm (2); low-complexity RENAL nephrometry score (1); dementia (2) or a modified cardiovascular index (CVI: 0, 1 or 2). To calculate the CVI, patients with congestive heart failure or more than one of the following disease states (cerebrovascular disease, coronary artery disease, peripheral vascular disease, chronic obstructive pulmonary disease, chronic kidney disease or diabetes mellitus) are assigned two points, patients with one risk factor are assigned one point. RESULTS At 57 months, among 4 institutions, 438 patients are enrolled: 177 elected AS, 261 primary intervention and 21 patients have crossed over from AS to intervention. Patients undergoing AS were older, had a higher ECOG performance status, worse CVI, smaller and less complex tumors. With a maximum DISSRM score of 11, median scores for intervention and AS were 3 and 4 respectively (p<0.001). 67% of intervention patients and 25% of AS patients had a score of ≤3; 19 and 49% of patients had a score ≥4 respectively. In the AS and primary intervention cohort, overall survival was 96.0% and 98.1% at 2 years, and 93.2% and 87.8% at 4 years respectively (p=0.65). DSS was 100% and 99% at 4 years respectively (p=0.73) as only one patient undergoing intervention died of renal cell cancer. CONCLUSIONS The DISSRM Score is a useful objective scoring method to differentiate patients with SRM most suitable for AS. Based on equivalent intermediate-term cancer-specific outcomes, the DISSRM score may act as an easy-to-calculate surrogate for competing risk mortality in patients with SRM. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e284-e285 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Phillip Pierorazio More articles by this author Deborah Kaye More articles by this author Matthew Danzig More articles by this author Rashed Ghandour More articles by this author Peter Chang More articles by this author Robert Hartman More articles by this author Andrew Wagner More articles by this author James McKiernan More articles by this author Mohamad Allaf More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...