Active surveillance (AS) using predefined progression criteria for intervention (PCI) appears to be well tolerated and allows most patients with small renal masses (SRMs) and a life expectancy longer than 20 years to avoid treatment for 5 years, according to a new study findings presented at the 2022 International Kidney Cancer Symposium: North America held in Austin, Texas.
Reported outcomes for AS in patients with SRMs have been heavily biased towards older and sicker patients, Muammer Altok, MD, and colleagues at Roswell Park Cancer Institute in Buffalo, New York, noted in a poster presentation. They assessed the safety, tolerability, and rates of delayed intervention in younger and healthier patients with SRMs. The study included 89 patients with SRMs managed with AS who had a life expectancy greater than 20 years. All patients had non-hereditary SRMs and did not meet predefined PCI at presentation.
Dr Altok’s team defined PCI as any SRM-related symptoms, unfavorable biopsy histology, cT3a stage, or having the longest tumor diameter (LTD) greater than 4 cm, a growth rate greater than 5 mm/year for LTD of 3 cm or less or a growth rate greater than 3 mm/year for LTD greater than 3 cm, without benign neoplastic biopsy histology.
The patients had a median age of 57 years and median follow-up of 44 months. PCI developed in 31 (35%) of the 89 patients. Of those 31 patients, 21 (68%) underwent surgery and 1 AS patient (1%) crossed over to intervention without PCI development. The 3- and 5-year PCI-free rates were 68% and 56%, respectively. The 3- and 5-year delayed intervention-free rates were 75% and 67%, respectively, the investigators reported. Metastasis did not develop in any patient.
The researchers concluded that AS using predefined PCI durably avoids treatment for many patients with SRMs with a life expectancy longer than 20 years. “PCI-free rates identified in this study may be useful to counsel AS patient candidates and inform AS research trial designs,” write the authors.
Altok M, Menon A, Aly A, et al. Outcomes of active surveillance for young and healthy patients with small renal masses. Presented at: 2022 International Kidney Cancer Symposium: North America, November 4-5, Austin, Texas. Abstract 12.