PD58-05 ACTIVE SURVEILLANCE VERSUS PRIMARY INTERVENTION FOR CLINICAL T1A KIDNEY TUMORS: HOW DOES RENAL BIOPSIES MODULATE MANAGEMENT PLAN? CONTEMPORARY RESULTS THE FIFTEEN-YEAR DISSRM PROSPECTIVE COMPARATIVE STUDY

You have accessJournal of UrologyKidney Cancer: Epidemiology & Evaluation/Staging/Surveillance III (PD58)1 May 2024PD58-05 ACTIVE SURVEILLANCE VERSUS PRIMARY INTERVENTION FOR CLINICAL T1A KIDNEY TUMORS: HOW DOES RENAL BIOPSIES MODULATE MANAGEMENT PLAN? CONTEMPORARY RESULTS THE FIFTEEN-YEAR DISSRM PROSPECTIVE COMPARATIVE STUDY Khalid Y. Alkhatib, Ian Mitchell Harmatz, Tina Wlajnitz, Nirmish Singla, Peter Chang, Andrew A. Wagner, Christian P. Pavlovich, James M. McKiernan, Thomas Guzzo, Mohamad E. Allaf, and Phillip M. Pierorazio Khalid Y. AlkhatibKhalid Y. Alkhatib , Ian Mitchell HarmatzIan Mitchell Harmatz , Tina WlajnitzTina Wlajnitz , Nirmish SinglaNirmish Singla , Peter ChangPeter Chang , Andrew A. WagnerAndrew A. Wagner , Christian P. PavlovichChristian P. Pavlovich , James M. McKiernanJames M. McKiernan , Thomas GuzzoThomas Guzzo , Mohamad E. AllafMohamad E. Allaf , and Phillip M. PierorazioPhillip M. Pierorazio View All Author Informationhttps://doi.org/10.1097/01.JU.0001008868.74763.2c.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Active surveillance (AS) for small renal masses (SRMs; clinical stage T1a) remains underutilized due to a lack of strong, prospective data. We herein report contemporary outcomes results in era of increase renal biopsies utilization from the Delayed Intervention and Surveillance for Small Renal Masses (DISSRM) Registry. METHODS: Since January, 2009, the DISSRM enrolled patients with a clinically localized, solid, enhancing renal mass ≤4.0 cm in diameter (cT1a). Patients can undergo delayed intervention (DI) or withdraw at any time. Protocol available at ClinicalTrials.gov (Identifier:NCT02346435). RESULTS: A total of 958 were enrolled, 377(39.35%) underwent PI and 581(60.65%) AS. The overall median follow-up time was 4.73 years (IQR: 2.13-7.18). Ultimately, 88 of 581 AS patients (15.15%) crossed over to DI after. The proportion of patients undergoing biopsies has increased from approximately 5% in the first 5 years to approximately 20%, 36 patients underwent biopsies. Of those 36, only 26 had an RCC (18 clear cell, 6 Papillary, and 2 unclassified type). CSS at 12-years was similar between PI and AS (99.3% vs 99.8%, respectively, log-rank p=0.43). OS was higher in patients undergoing PI compared to AS at 3-years (97.6% vs 92.9%), 6-years (92.8% vs 81.2%), 9-years (88.0% vs 63.7%), and 12-years (41.6% vs 57.9%) log-rank p<0.001. The median overall GR was 0.11 cm/year (IQR 0-0.33 cm/year), and 183 experienced a progression event. PFS was 84.3% at 3-years, 78.2% at 6-years, 77.3% at 9-years. Crossover rate is 15.16% (88/581) and was significantly different as the tumor size increases as fellow; size <2 cm; 10.28% (11/107), 2 to <3 cm; 16.25% (26/160); and ≥3 cm; 25.76% (51/198). RFS was not different between PI and DI (p=0.24). CONCLUSIONS: Given the absence of a randomized trial, DISSRM demonstrates the best available evidence of AS for SRM and confirms its safety a management strategy. Additionally, the results provide an opportunity to refine the approach to AS, including criteria for crossover to intervention. Tumor size at enrollment predicts DI and biological outcomes and should be considered the primary trigger for DI. Download PPTDownload PPT Source of Funding: N/A © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e1215 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Khalid Y. Alkhatib More articles by this author Ian Mitchell Harmatz More articles by this author Tina Wlajnitz More articles by this author Nirmish Singla More articles by this author Peter Chang More articles by this author Andrew A. Wagner More articles by this author Christian P. Pavlovich More articles by this author James M. McKiernan More articles by this author Thomas Guzzo More articles by this author Mohamad E. Allaf More articles by this author Phillip M. Pierorazio More articles by this author Expand All Advertisement PDF downloadLoading ...