1359 RENAL MASSES UNDER ACTIVE SURVEILLANCE ARE MORE OFTEN RADIOGRAPHICALLY “SIMPLE” THAN THOSE UNDERGOING IMMEDIATE INTERVENTION (2010)

You have accessJournal of UrologyKidney Cancer: Localized IV1 Apr 20101359 RENAL MASSES UNDER ACTIVE SURVEILLANCE ARE MORE OFTEN RADIOGRAPHICALLY “SIMPLE” THAN THOSE UNDERGOING IMMEDIATE INTERVENTION Alexander Kutikov, Zachary J. Piotrowski, Brandon J. Manley, Daniel J. Canter, Brian L. Egleston, Michelle Collins, Rosalia Viterbo, Stephen A. Boorjian, David Y.T. Chen, Richard E. Greenberg, and Robert G. Uzzo Alexander KutikovAlexander Kutikov More articles by this author , Zachary J. PiotrowskiZachary J. Piotrowski More articles by this author , Brandon J. ManleyBrandon J. Manley More articles by this author , Daniel J. CanterDaniel J. Canter More articles by this author , Brian L. EglestonBrian L. Egleston More articles by this author , Michelle CollinsMichelle Collins More articles by this author , Rosalia ViterboRosalia Viterbo More articles by this author , Stephen A. BoorjianStephen A. Boorjian More articles by this author , David Y.T. ChenDavid Y.T. Chen More articles by this author , Richard E. GreenbergRichard E. Greenberg More articles by this author , and Robert G. UzzoRobert G. Uzzo More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.987AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Active surveillance (AS) of enhancing renal mass is an acknowledged strategy, particularly in the aged or infirmed. The subjectivity of clinical decision making for renal masses (excise, ablate, observe) is also well recognized. We hypothesized that radiographically less complex lesions are deemed clinically less “worrisome” and therefore more likely to be considered for AS. Here we test this hypothesis using nephrometry and compare patients who underwent an initial course of AS to those who proceeded to immediate surgery. METHODS We queried our prospective institutional Kidney Cancer Database for patients treated for renal mass in whom a nephrometry score was available. Patients undergoing an initial period of AS were compared to those who went directly to surgery using the individual components of nephrometry (size, endo/exophycity, nearness to sinus/urothelium, anterior/posterior, location relative to polar line and hilar structures) and the total nephrometry score. The Wilcoxon Rank-Sum and Fisher's Exact tests were used. RESULTS We identified 172 patients (median age 76, range 39-93) with renal mass who underwent an initial period of AS of which nephrometry was available in 153. When compared to patients who underwent immediate surgical treatment (n=386), patients on active surveillance had lower nephrometry scores (median score 7.1 versus 8.3) (p<0.0001) demonstrating those perceived to be “simpler” may also be thought to be biologically less “risky”. Specifically, lesions undergoing AS were smaller, further from the sinus or urothelium, more often polar and less often hilar (p<0.0015 all comparisons) (Table 1). Table 1. Comparison of the R.E.N.A.L. Nephrometry Scores between patients with renal mass who were placed on active surveillance and those who underwent immediate renal surgery. AS Patients (n=153) Surgical Patients (n=386) p value Nephrometry Score mean (median, SD) 7.13(7,1.98) 8.31(9,1.87) <0.0001 (R)adius (diameter) 1=82.0% 2=14.4% 3=3.9% 1=49.0% 2=25.4% 3=25.7% <0.001 (E)xophytic/endophytic properties 1=39.9% 2=49.0% 3=11.1% 1=46.1% 2=41.2% 3=12.7% 0.269 (N)earness of the tumor to the collecting system or sinus 1=34.6% 2=12.4% 3=52.9% 1=20.2% 2=5.2% 3=74.6% <0.001 (A)nterior or (p)osterior or (x) a=46.4% p=39.2% x=14.4% a=46.8% p=34.3% x=19.0% 0.372 (L)ocation relative to the polar lines* 1=38.6% 2=20.9% 3=40.5% 1=20.0% 2=26.2% 3=53.9% <0.001 “H”ilar location (abutting main artery or vein) Hilar=8% Hilar=19% 0.001 Non-hilar=92% Non-hilar=81% CONCLUSIONS Perceptions exist that radiographically less “complex” tumors are more indolent. Here we demonstrate that the anatomical features of renal masses of patients under AS are less often central, large or hilar. Recent data suggesting that worse tumor histology and grade are also associated with anatomically more complex lesions as measured by nephrometry indicate there may be a biological basis for placing smaller, less central, peripheral, polar and non-hilar lesions on AS in the appropriate clinical circumstance. These data demonstrate that tumor anatomy significantly influences clinical decision-making. Philadelphia, PA© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e525 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alexander Kutikov More articles by this author Zachary J. Piotrowski More articles by this author Brandon J. Manley More articles by this author Daniel J. Canter More articles by this author Brian L. Egleston More articles by this author Michelle Collins More articles by this author Rosalia Viterbo More articles by this author Stephen A. Boorjian More articles by this author David Y.T. Chen More articles by this author Richard E. Greenberg More articles by this author Robert G. Uzzo More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...