Re: Use of Delayed Intervention for Small Renal Masses Initially Managed with Active Surveillance
| Autor: | Michael H. Johnson, Phillip M. Pierorazio, Mohit Gupta, Ridwan Alam, James M. McKiernan, Alice Semerjian, Hiten D. Patel, Andrew A. Wagner, Peter Chang, Mohamad E. Allaf, Michael A. Gorin |
|---|---|
| Přispěvatelé: | Biomedical Engineering and Physics, APH - Quality of Care, APH - Personalized Medicine, Urology, CCA - Cancer Treatment and Quality of Life |
| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty Urology medicine.medical_treatment 030232 urology & nephrology 03 medical and health sciences Text mining 0302 clinical medicine Interquartile range Biopsy medicine Carcinoma Humans Intensive care medicine Carcinoma Renal Cell Aged Percutaneous cryoablation medicine.diagnostic_test business.industry Middle Aged medicine.disease Nephrectomy Kidney Neoplasms Surgery Oncology Delayed intervention 030220 oncology & carcinogenesis Female Functional status business Kidney cancer |
| Zdroj: | Journal of urology, 202(2). Elsevier Inc. |
| ISSN: | 0022-5347 |
| Popis: | A number of patients who elect active surveillance of their small renal masses (≤4 cm) subsequently pursue delayed intervention (DI). The indications, timing, and rates of DI have not been well determined prospectively.Data from Delayed Intervention and Surveillance for Small Renal Masses, a prospective, multi-institutional registry was utilized to evaluate factors associated with DI between 2009 and 2018.Of 371 patients enrolled in AS, 46 (12.4%) pursued DI. Patients who pursued DI spent a median 12 months on surveillance (interquartile range 5.5-23.6), had better functional status (P0.01), and had greater median growth rate vs. those who remained on surveillance (0.38 vs. 0.05, P0.001). Indications for intervention included growth rate0.5 cm/y for 23 (50%) patients, patient preference for 22 (47.8%) patients, and qualification for renal transplant in 1 (2.2%) patient. Thirty-two patients (69.6%) underwent nephron-sparing surgery, 5 (10.9%) underwent radical nephrectomy, and 9 (19.6%) underwent percutaneous cryoablation. Renal mass biopsy was utilized in 37 (11.4%) and 15 (32.7%) patients in the AS and DI arms, respectively (P = 0.04). No patients experienced metastatic progression or died of kidney cancer.As nearly 50% of patients pursue DI secondary to anxiety in the absence of clinical progression, comprehensive counseling is essential to determine if patients are suitable for a surveillance protocol. AS remains a safe initial management option for many patients but may not be a durable strategy for patients who are acceptable surgical candidates with an extended life expectancy. DI does not compromise oncologic outcomes or limit treatment options. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|