AS Safe for Cystic Renal Masses in Selected Patients

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In a single-center study, 24% of patients crossed over to treatment and 95% of patients were alive after 5 years of follow-up.
In a single-center study, 24% of patients crossed over to treatment and 95% of patients were alive after 5 years of follow-up.
The following article is part of conference coverage from the 2017 American Urological Association meeting in Boston. Renal and Urology News' staff will be reporting live on medical studies conducted by urologists and other specialists who are tops in their field in kidney stones, prostate cancer, kidney cancer, bladder cancer, enlarged prostate, and more. Check back for the latest news from AUA 2017. 

BOSTON—Active surveillance (AS) with or without delayed intervention is a successful management approach for well-selected patients with localized cystic renal masses, researchers reported at the American Urological Association 2017 annual meeting.

In a study, Andrew McIntosh, MD, and colleagues at Fox Chase Cancer Center in Philadelphia, found that these patients were less likely to proceed to delayed intervention and had a significantly slower mean change in estimated tumor volume (ETV) compared with patients on AS for solid renal masses.

The study included 601 patients on AS for renal masses and who had 5 or more years of follow-up. The group included 196 patients who had cystic renal masses (CRMs) and 405 who had solid renal masses (SRMs). The CRM cohort had a median follow-up of 59.7 months. Forty-eight CRM patients (24%) crossed over to delayed intervention during a median time of 16.7 months.

A significantly smaller proportion of patients with CRMs than SRMs proceeded to treatment (23.3% vs 33.9%). Of the patients with CRMs who crossed over to delayed intervention, 64% did so within 2 years.

In the CRM group, younger patients were more likely to crossover to delayed intervention than older patients (57.2 vs 64.4 years). The mean change in ETV of the cystic masses was 5.8 cm3 per year compared with 11.4 cm3 among patients with SRMs. In the SRM cohort, the mean linear growth rate of the masses was 2.6 mm per year. At 5 years, 95.4% of the CRM patients were alive.

Dr McIntosh's team also looked at a subset of 37 CRM patients who had 5 or more years of follow-up without crossing over to delayed intervention. All were alive and only 1 patient experienced distant metastases. The mean linear growth rate for this subset was 0.1 mm per year.

Visit Renal and Urology News' conference section for continuous coverage from AUA 2017.

Reference

McIntosh A, Parikh P, Tokarski A, et al. Active surveillance for cystic renal masses with ≥5 years of follow-up. [abstract]. J Urol 2017;197(4S):e90. Presented as a moderated poster at the American Urological Association 2017 annual meeting in Boston on May 12. MP08-01.

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