PD17-05 TUMOR ANATOMIC COMPLEXITY PREDICTS GROWTH KINETICS OF RENAL MASSES UNDER ACTIVE SURVEILLANCE (2014)

You have accessJournal of UrologyKidney Cancer: Localized II1 Apr 2014PD17-05 TUMOR ANATOMIC COMPLEXITY PREDICTS GROWTH KINETICS OF RENAL MASSES UNDER ACTIVE SURVEILLANCE Reza Mehrazin, Marc C. Smaldone, Brian Egleston, Charlie Concodora, Jeffrey J. Tomaszewski, Philip Abbosh, Timothy Ito, Jason Lomboy, Alexander Chow, Rosalia Viterbo, Richard E. Greenberg, David Y.T. Chen, Alexander Kutikov, and Robert G. Uzzo Reza MehrazinReza Mehrazin More articles by this author , Marc C. SmaldoneMarc C. Smaldone More articles by this author , Brian EglestonBrian Egleston More articles by this author , Charlie ConcodoraCharlie Concodora More articles by this author , Jeffrey J. TomaszewskiJeffrey J. Tomaszewski More articles by this author , Philip AbboshPhilip Abbosh More articles by this author , Timothy ItoTimothy Ito More articles by this author , Jason LomboyJason Lomboy More articles by this author , Alexander ChowAlexander Chow More articles by this author , Rosalia ViterboRosalia Viterbo More articles by this author , Richard E. GreenbergRichard E. Greenberg More articles by this author , David Y.T. ChenDavid Y.T. Chen More articles by this author , Alexander KutikovAlexander Kutikov 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.2014.02.1512AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Introduction and Objectives Active surveillance (AS) for small renal masses has emerged as a viable clinical strategy in patients with significant competing risks of death. Using our large institutional cohort, we explored the association between clinical variables and tumor yearly linear growth rate (LGR). Methods Our institutional, prospectively maintained, renal tumor database was reviewed to identify enhancing renal masses managed expectantly for at least 6 months from 2000−2012. Hereditary disease and biopsy proven non-renal cell lesions were excluded. Linear regressions of growth rates estimated by Generalized Estimating Equations were used. The association between patient and tumor characteristics and LGR were assessed using generalized estimating equations, controlling for age, Charlson score, race, sex, and initial tumor size. Results 381 patients (395 masses) meeting inclusion criteria were identified (17% ≥cT1b), with a mean follow up of 32.9±21.1 months. 46% of patients progressed to definitive intervention with a mean duration of 23±17 months. Comparing patients managed expectantly to those requiring intervention, no difference was seen in tumor size at presentation (2.6 vs. 2.6cm), while significant differences in median age (71 vs. 64 years, p<0.001), Charlson co-morbidity score (3 vs. 2, p<0.001), and LGR (0.23 vs. 0.49cm/year, p<0.001) were observed between groups. Anatomic complexity quantified by the RENAL Nephrometry score (NS) was not different between groups (6.9 vs. 7.0, p=0.7). In the adjusted model, for each 1 point increase in Nephrometry score sum, average tumor LGR increased by 0.036 cm/year (p=0.010). Of the entire cohort, 6 patients (1.6%) progressed to metastatic disease. Conclusions Our institutional experience adds to the growing body of literature that suggests a short term period of AS, to determine renal mass growth kinetics, is safe in the elderly and comorbid. The demonstrated association between anatomic tumor complexity, as captured by the RENAL NS, and tumor linear growth rate may afford clinically useful cues to tailor individual patient radiographic surveillance schedules. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e541 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Reza Mehrazin More articles by this author Marc C. Smaldone More articles by this author Brian Egleston More articles by this author Charlie Concodora More articles by this author Jeffrey J. Tomaszewski More articles by this author Philip Abbosh More articles by this author Timothy Ito More articles by this author Jason Lomboy More articles by this author Alexander Chow More articles by this author Rosalia Viterbo More articles by this author Richard E. Greenberg More articles by this author David Y.T. Chen More articles by this author Alexander Kutikov More articles by this author Robert G. Uzzo More articles by this author Expand All Advertisement Advertisement Loading ...