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Conditional survival of patients with small renal masses undergoing active surveillance.

Authors
  • Petros, Firas G1
  • Venkatesan, Aradhana M2
  • Kaya, Diana2
  • Ng, Chaan S2
  • Fellman, Bryan M3
  • Karam, Jose A1
  • Wood, Christopher G1
  • Matin, Surena F1
  • 1 Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
  • 2 Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
  • 3 Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Type
Published Article
Journal
British Journal of Urology
Publisher
Wiley (Blackwell Publishing)
Publication Date
Mar 01, 2019
Volume
123
Issue
3
Pages
447–455
Identifiers
DOI: 10.1111/bju.14486
PMID: 30007044
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

To determine conditional survival for patients with small renal masses (SRMs) undergoing active surveillance (AS). Patients were enrolled in a prospective AS protocol at our institution between May 2005 and January 2016. Patients with SRMs ≤4 cm with serial cross-sectional imaging available in-house for review were included. Overall survival (OS) was estimated using the Kaplan-Meier method and modelled via Cox proportional hazards models. The primary endpoints analysed were the conditional probability of survival and tumour growth over time. Landmark analysis was used to evaluate survival outcomes beyond the 2-year mark after the initial scan. The relative conditional survival of patients on AS was compared to those undergoing partial nephrectomy (PN) using inverse probability of treatment weighting. A total of 272 patients were included in this analysis. The mean initial SRM size was 1.74 ± 0.77 cm, and the mean mass size closest to the 2-year mark was 1.97 ± 0.83 cm. The likelihood of continued survival to 5 years improved after the 2-year landmark. Patients with masses <3 cm who survived the first 2 years on AS had a 0.84-0.85 chance of surviving to 5 years, and if they survived 3 years, the probability of surviving to 5 years improved to 0.91. A slow tumour growth (β: 0.12; P < 0.001) with parallel growth rates was found for tumours <3 cm. Patients on AS and those who underwent PN had similar OS for ~7 years, beyond which PN demonstrated a trend of lower risk of death compared with AS (hazard ratio 0.57; P = 0.07). The conditional survival probability of patients with SRMs <3 cm on AS increased after 2 years. This information may prove useful to urologists and patients who are considering continuing AS vs intervention after the first 2 years on AS. © 2018 The Authors BJU International © 2018 BJU International Published by John Wiley & Sons Ltd.

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