Active surveillance ‘viable option’ for SRM management

By Shreeya Nanda, Senior medwireNews Reporter

US researchers find no significant difference in survival outcomes between patients with small renal masses (SRMs) who opt for active surveillance and those who choose immediate treatment.

Although follow-up data are not mature, the short- to intermediate-term findings are promising and suggest that active surveillance is a “viable option” for select patients, says the team led by Phillip Pierorazio, from Johns Hopkins Medicine in Baltimore, Maryland, in European Urology.

Of 497 patients with a localised SRM (≤4 cm) on axial imaging who were recruited to the multi-institutional Delayed Intervention and Surveillance for Small Renal Masses (DISSRM) registry, 45.0% chose active surveillance, with 9.4% subsequently undergoing delayed intervention, and 55.0% opted for primary intervention, with immediate surgery or ablation.

Patients managed by active surveillance were significantly older and had significantly more comorbidities than those who received immediate treatment, leading Michael Jewett (University of Toronto, Ontario, Canada) and co-authors to comment in an accompanying editorial that the active surveillance uptake rate of 40%, excluding those who crossed over to delayed intervention, is “not surprising”. They add that the rate “reflects the good advice that the patients received”.

During a median follow-up of 2.1 years, no deaths in the active surveillance and two in the primary intervention cohort were attributed to renal cell carcinoma, a finding that the editorialists label “ironic”.

Overall survival rates at 2 and 5 years did not differ significantly between the active surveillance and primary intervention modalities, at 96% versus 98% and 75% versus 92%, respectively. And neither did cancer-specific mortality at 5 years, with corresponding rates of 100% and 99%.

Among the active surveillance group, rates of progression-free survival, including opting for delayed intervention, at 2 and 5 years were 95% and 67%, respectively.

In univariate regression analysis, the association between active surveillance and all-cause mortality “did not meet conventional levels of statistical significance”, say the study authors. And age and cardiovascular index scores were the only significant predictors of all-cause mortality.

“[Active surveillance] with delayed intervention appears to be a noninferior management strategy with regard to oncologic outcomes for well-selected patients with SRM according to short- to intermediate-term follow-up”, conclude Pierorazio et al.

They recommend that active surveillance be considered a part of the standard discussion for SRM management.

But in light of the short follow-up duration, Jewett et al conclude on a note of caution saying that they “await longer follow-up from the registry and other cohorts to see if they validate the [overall survival] observation.”

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