Enrichment for adverse pathology in resected small renal masses that meet objective progression criteria during active surveillance

You have accessJournal of UrologyCME1 Apr 2023MP64-12 ENRICHMENT FOR ADVERSE PATHOLOGY IN RESECTED SMALL RENAL MASSES THAT MEET OBJECTIVE PROGRESSION CRITERIA DURING ACTIVE SURVEILLANCE Muammer Altok, Arun Menon, Ahmed Aly, Tashionna White, Gaybrielle James, Bo Xu, Michael Petroziello, Charles Roche, and Eric Kauffman Muammer AltokMuammer Altok More articles by this author , Arun MenonArun Menon More articles by this author , Ahmed AlyAhmed Aly More articles by this author , Tashionna WhiteTashionna White More articles by this author , Gaybrielle JamesGaybrielle James More articles by this author , Bo XuBo Xu More articles by this author , Michael PetrozielloMichael Petroziello More articles by this author , Charles RocheCharles Roche More articles by this author , and Eric KauffmanEric Kauffman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003322.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Active surveillance (AS) is increasingly used in small renal mass (SRM) patients, however there is no uniform agreement on specific tumor progression criteria to trigger delayed intervention (DI). Ideal progression criteria for intervention (PCI) would selectively treat SRM with adverse pathology (15-25% of all SRM). However, patient factors (e.g., anxiety) have been the most common trigger for DI to date, which has challenged studying the efficacy of specific PCI thresholds. Recently, we described our AS experience prospectively using pre-defined PCI to almost exclusively trigger DI. The current study aimed to characterize pathologic outcomes of DI resection cases to assess the efficacy of these PCI thresholds for selecting SRM with adverse pathology. METHODS: From January 2013-April 2021, all patients with SRM seen at a cancer center were recommended AS if predefined PCI were absent, and DI was recommended only upon new PCI development. PCI were defined prospectively as any SRM-related symptoms, unfavorable biopsy histology, cT3a stage, or any of the following without benign neoplastic biopsy histology: longest tumor diameter (LTD) >4 cm; growth rate (GR) >5 mm/year for LTD ≤3cm or >3 mm/year for LTD >3 cm. Rates of adverse pathology were retrospectively assessed in DI resections and stratified by specific PCI thresholds met. RESULTS: Of 255 SRM patients with 31 months median follow up on AS, there were no metastases and new PCI was diagnosed in 67 (26%), of which 46 (69%) underwent DI, including 41 resections (39 partial, 2 radical). Only 1 DI resection was due to patient factors alone. All 41 DI resections were malignant and most (59%) had adverse pathology, including 51% high grade and 20% pT3a. Rapid GR was the most common trigger of DI (alone= 71% of DI cases; concomitant with LTD >4 cm=22% of DI cases), while LTD >4 cm alone was responsible for only 7% of DI cases. Biopsy histology, cT3a upstaging and symptoms were uncommonly met PCI thresholds (n=3) that were always accompanied by rapid growth and had adverse pathology in most (n=2) cases. CONCLUSIONS: Prospectively applied PCI thresholds defined herein effectively identified aggressive SRM cases for DI conversion, given notably higher rates of adverse pathology at DI compared to those historically reported for SRM resections. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e885 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Muammer Altok More articles by this author Arun Menon More articles by this author Ahmed Aly More articles by this author Tashionna White More articles by this author Gaybrielle James More articles by this author Bo Xu More articles by this author Michael Petroziello More articles by this author Charles Roche More articles by this author Eric Kauffman More articles by this author Expand All Advertisement PDF downloadLoading ...