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Minerva Urologica e Nefrologica 2020 Sep 29

DOI: 10.23736/S0393-2249.20.03785-6

Copyright © 2020 EDIZIONI MINERVA MEDICA

lingua: Inglese

Active surveillance for small renal masses in elderly patients does not increase overall mortality rates compared to primary intervention: a propensity score weighted analysis

Michele MARCHIONI 1, 2, Joseph G. CHEAIB 3, Toshio TAKAGI 4, Nicola PAVAN 5, Alessandro ANTONELLI 6, Wouter EVERAERTS 7, Matthias HECK 8, Koon H. RHA 9, Alexandre MOTTRIE 10, Jihad KAOUK 11, Umberto CAPITANIO 12, Estevão Lima 13, Alessandro VECCIA 6, 14, Simone CRIVELLARO 15, Estefania LINARES 16, Antonio CELIA 17, Francesco PORPIGLIA 18, Riccardo AUTORINO 14, Marta DI NICOLA 1, Luigi SCHIPS 2, Phillip M. PIERORAZIO 3, Maria Carmen MIR 19

1 Department of Medical, Oral and Biotechnological Sciences, Laboratory of Biostatistics, G. D’Annunzio University, Chieti, Italy; 2 Department of Urology, SS Annunziata Hospital, G. D’Annunzio University, Chieti, Italy; 3 Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins Medicine, Baltimore, MD, USA; 4 Department of Urology, Kidney Center, Tokyo Women’s Medical University, Tokyo, Japan; 5 Department of Medical, Surgical and Health Science, Clinic of Urology, University of Trieste, Trieste, Italy; 6 Department of Urology, Spedali Civili Hospital, University of Brescia, Brescia, Italy; 7 Department of Urology, KU Leuven, Leuven, Belgium; 8 Department of Urology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany; 9 Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea; 10 Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium; 11 Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA; 12 Unit of Urology, Division of Oncology, Urological Research Institute, IRCCS San Raffaele Hospital, Milan, Italy; 13 Department of Urology, Hospital of Braga, Braga, Portugal; 14 Division of Urology, VCU Medical Center, Richmond, VA, USA; 15 Department of Urology, University of Illinois, Chicago, IL, USA; 16 Department of Urology, La Paz University Hospital, Madrid, Spain; 17 Department of Urology, San Bassiano Hospital, Bassano del Grappa, Vicenza, Italy; 18 Department of Urology, School of Medicine, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy; 19 Department of Urology, Instituto Valenciano de Oncología (IVO), Valencia, Spain



BACKGROUND: To test the effect of active surveillance (AS) versus primary intervention (PI) on overall mortality (OM) in elderly patients diagnosed with SRM.
METHODS: Elderly patients (75 years or older) diagnosed with SRMs (< 4cm) and treated with either PI [i.e. partial nephrectomy or kidney ablation] or AS between 2009 and 2018 were abstracted from the REnal SURGery in the Elderly (RESURGE) and Delayed Intervention and Surveillance for Small Renal Masses (DISSRM) datasets, respectively. OM rates were estimated among groups with Kaplan Meier method and Cox proportional hazards regression models after applying inverse probability of treatment weighting (IPTW). Multivariable logistic regression model was used to estimate IPTW. Covariates of interest were those unbalanced and/or significantly correlated with the treatment choice or with OM.
RESULTS: A total of 483 patients were included; 121 (25.1%) underwent AS. 60 patients (12.4%) died. Overall, 6.7% of all deaths were related to cancer. IPTW-Kaplan Meier curves showed a 5-year overall survival rates of 70.0 ± 3.5% and 73.2 ± 4.8% in AS and PI groups, respectively (IPTW-Log-rank p-value=0.308). IPTW-Cox regression model did not show meaningfully increased OM rates in AS group (HR=1.31, 95% CI: 0.69-2.49).
CONCLUSIONS: AS represents an appealing treatment option for very elderly patients presenting with SRM, as it avoids the risks of a PI while not compromising the survival outcomes of these patients.


KEY WORDS: Small renal masses; Nephron sparing surgery; Active surveillance; Kidney cancer; Elderly

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