NEW ORLEANS, LA USA (UroToday.com) - In this poster presentation, Dr. Phillip Pierorazio presented results from the Delayed Intervention and Surveillance for Small Renal Masses (DISSRM) Registry, prospectively examining the safety of an active surveillance protocol in comparison to immediate intervention in patients presenting with small renal masses (≤ 4cm). The active surveillance protocol involved imaging every 4-6 months in the first 2 years and then every 6-12 months for 3 years. The study was powered as a non-inferiority study, designed to detect a 5% difference in disease-specific survival at 5 years.
The authors reported that as of November 2014, nearly 500 patients were enrolled in the study with 55% electing for immediate intervention and 45% active surveillance. Patients choosing active surveillance were older and were more likely to be female. They were also more likely to have more comorbid conditions, with higher Charlson comorbidity index score, higher cardiovascular index, and worse ECOG performance status. Patients on active surveillance were more likely to have undergone a biopsy, and the result of the biopsy was more likely to have returned benign when compared to patients who underwent immediate intervention. Patients on active surveillance also had smaller tumors, and were more likely to have multiple tumors.
At a median follow up the authors reported that overall survival for patients undergoing immediate intervention versus active surveillance was 98% and 96% at 2 years, and 92% and 75% at 5 years, respectively. This difference was not statistically significant. Cancer-specific survival at 5 years was high at 99% for immediate intervention and 100% for active surveillance. The authors noted that on univariate regression modeling, active surveillance was not predictive of overall or cancer-specific survival, though age and cardiovascular index score > 1 were. No patients on active surveillance developed metastatic disease, however 9% ultimately underwent a delayed intervention.
Based on this data, the authors concluded that active surveillance with delayed intervention was not an inferior management strategy in comparison to immediate intervention with regards to oncologic outcomes.
Presented by Phillip Pierorazio, MD at the American Urological Association (AUA) Annual Meeting - May 15 - 19, 2015 - New Orleans, LA USA
The Johns Hopkins Hospital, Baltimore, MD USA
Reported by Timothy Ito, MD, medical writer for UroToday.com