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PD46-11 ACTIVE SURVEILLANCE OF RENAL MASSES – THE MEMORIAL SLOAN-KETTERING EXPERIENCE
THE JOURNAL OF UROLOGYâ
e1128
Vol. 195, No. 4S, Supplement, Tuesday, May 10, 2016
primary intervention for cancer specific survival (CSS) was analyzed. Demographic and clinical characteristics, including cancer specific information and comorbidities, were compared between the two groups using t test and chi-square testing as appropriate. Objective criteria were developed a priori based on evidence at the initiation of the registry and were modified as experience was gained. The DISSRM Score was developed from the most predictive combination of factors associated with increased suitability for AS. RESULTS: Of the 535 patients, 253 (47%) selected active surveillance and 282 (53%) underwent primary intervention. AS patients were older, had worse CCI scores, and had more cardiovascular and total comorbidities. Points were assigned for age, modified-cardiovascular-index, dementia, and R.E.N.A.L-nephrometry score. With a maximum score of 8, the average DISSRM score was 2.09 in the AS cohort and 1.19 for PI patients. Notably, 80% of the patients in the PI arm had a score < or ¼2, compared to 30% in AS. The DISSRM Score achieved an AUC of 0.701. CONCLUSIONS: The DISSRM Score is a useful objective scoring method to differentiate patients with SRM most suitable for AS. Although prospective validation is required, the DISSRM score may act as an easy-to-calculate surrogate for competing risk mortality in patients with SRM.
number of comorbidities, but it was positively associated with delayed treatment of RM. CONCLUSIONS: RM growth rate and patient comorbidities are significant determinants for delayed intervention in patients with competing health risks initially managed with surveillance. Slower growth rate was associated with coexistence of simple cyst. In patients with competing morbidities, the risk of dying from kidney cancer is low. Initial observation of renal masses to determine growth characteristics is safe in this group of patients managed with selective intervention.
Source of Funding: Johns Hopkins SOM Dean’s funding and Persky Urology Award
INTRODUCTION AND OBJECTIVES: Renal mass biopsy has gained acceptance and is recommended for the evaluation of small renal masses (SRM) in patients where the biopsy result will impact management. Contemporary renal biopsies are performed exclusively in a hospital setting followed by a reasonable interval of observation for post procedural complications. Here, we present the first study to evaluate ultrasound guided percutaneous renal core biopsy performed in the office setting. METHODS: This is a retrospective study involving 108 patients who underwent office based ultrasound guided percutaneous renal biopsy for the evaluation of a solid renal mass between April 2010 and October 2015. Baseline vital signs and ultrasound were performed prior to core biopsy. If the mass was deemed amenable to biopsy, patients underwent ultrasound guided biopsy by one of three urologic oncologists. Patients were observed for 1 hour after the procedure and repeat vital signs and ultrasound were performed. Hemodynamically stable patients without developing hematoma were discharged home with appropriate follow up. Descriptive statistics were performed. RESULTS: In the 108 patients (70% male, mean age 68 years), average mass size was 3.95cm. Biopsy yield was as follows: 72/108 (66.7%) Renal Cell Carcinoma (RCC), 11/108 (10.19%) Oncocytoma, 6/108 (5.56%) Angiomyolipoma, 2/108 (1.85%) Lymphoma, and 17/108 (15.74%) benign histology. The non-diagnostic rate leading to re-biopsy was 5.56%. 25.93% of patients were observed while 73.15% of patients went on to receive surgery or ablative therapy. Final pathology was concordant with biopsy results in 64/65 (98.4%) of cases. Only one patient experienced a grade one Clavien-Dindo surgical complication, which was a small perirenal hematoma, which was managed with analgesics and did not require hospitalization. CONCLUSIONS: Office based ultrasound guided renal core biopsy is potentially as safe and efficacious as standard hospital based CT guided biopsy. Additionally, ultrasound guided biopsy potentially offers improved dynamic characterization of SRM, greater convenience and availability to patients as well as tremendous overall cost savings.
PD46-11 ACTIVE SURVEILLANCE OF RENAL MASSES e THE MEMORIAL SLOAN-KETTERING EXPERIENCE Nick Liu*, Cheryn Song, Katie Murray, Alan Thong, Paul Russo, Jonathan Coleman, New York City, NY INTRODUCTION AND OBJECTIVES: Active surveillance is an accepted management of renal masses (RM) in appropriately selected patients. We describe the growth characteristics of renal mass under surveillance, identify factors associated with growth rate and evaluate associated outcomes in a large series of patients with competing morbidities. METHODS: From the institutional database, we identified 460 renal masses from 398 patients diagnosed between 1993 and 2013 followed radiographically for at least 12 months without definitive therapy. Maximal mass diameter was obtained from all images and individual growth rate obtained using slope of linear regression. Clinical factors were evaluated for their association with RM growth rate, interventions, pathologic and survival outcomes using linear and logistic regression as well as Cox proportional hazards model. RESULTS: Median patient age was 69 years (IQR 61, 75) and 84% had significant comorbidity including 33% with Charlson comorbidity index greater than 3. Median initial tumor size was 2cm (IQR 1.3, 3.0) and 70 RM (15%) were cT1b or greater tumors. Median RM growth rate was 0.15cm/year (IQR 0.01, 0.36). Presence of coexisting simple cyst in the ipsilateral kidney was independently associated with lower RM growth rate (B¼-0.15, 95%CI [-0.25, -0.05], p¼0.005). Management was altered to treatment in 178 (39%) RM after a median surveillance period of 34 months (IQR 19, 56). Patients with faster growth rate (OR: 5.6, 95%CI [2.9, 11]), younger age (OR: 0.95, 95%CI [0.92, 0.96]), and higher GFR (OR: 2.0, 95%CI [1.2, 3.4]) were more likely to undergo delayed treatment than continuing with surveillance. In the 219 (48%) RM with histologic diagnosis, cancer was identified in 88%. Compared to benign RM, malignant RM grew faster (0.3 vs. 0.08 cm/year, p¼0.001). At a median follow-up of 61 months (IQR 43, 100), 11 (3%) had metastatic RCC and 8 (2%) died of kidney cancer; 77 patients (19%) died of causes other than kidney cancer. On Cox regression, overall survival was negatively associated with patient age >75 and increasing
Source of Funding: None
PD46-12 OFFICE BASED ULTRASOUND GUIDED RENAL CORE BIOPSY IS SAFE AND EFFICACIOUS IN THE MANAGEMENT OF SMALL RENAL MASSES Chirag Dave*, Brian Seifman, Rene Frontera, Ryan Nelson, Heather Crossley, Travis Washington, Preston Kerr, Edward Schervish, Royal Oak, MI
Source of Funding: None
e1128
Vol. 195, No. 4S, Supplement, Tuesday, May 10, 2016
primary intervention for cancer specific survival (CSS) was analyzed. Demographic and clinical characteristics, including cancer specific information and comorbidities, were compared between the two groups using t test and chi-square testing as appropriate. Objective criteria were developed a priori based on evidence at the initiation of the registry and were modified as experience was gained. The DISSRM Score was developed from the most predictive combination of factors associated with increased suitability for AS. RESULTS: Of the 535 patients, 253 (47%) selected active surveillance and 282 (53%) underwent primary intervention. AS patients were older, had worse CCI scores, and had more cardiovascular and total comorbidities. Points were assigned for age, modified-cardiovascular-index, dementia, and R.E.N.A.L-nephrometry score. With a maximum score of 8, the average DISSRM score was 2.09 in the AS cohort and 1.19 for PI patients. Notably, 80% of the patients in the PI arm had a score < or ¼2, compared to 30% in AS. The DISSRM Score achieved an AUC of 0.701. CONCLUSIONS: The DISSRM Score is a useful objective scoring method to differentiate patients with SRM most suitable for AS. Although prospective validation is required, the DISSRM score may act as an easy-to-calculate surrogate for competing risk mortality in patients with SRM.
number of comorbidities, but it was positively associated with delayed treatment of RM. CONCLUSIONS: RM growth rate and patient comorbidities are significant determinants for delayed intervention in patients with competing health risks initially managed with surveillance. Slower growth rate was associated with coexistence of simple cyst. In patients with competing morbidities, the risk of dying from kidney cancer is low. Initial observation of renal masses to determine growth characteristics is safe in this group of patients managed with selective intervention.
Source of Funding: Johns Hopkins SOM Dean’s funding and Persky Urology Award
INTRODUCTION AND OBJECTIVES: Renal mass biopsy has gained acceptance and is recommended for the evaluation of small renal masses (SRM) in patients where the biopsy result will impact management. Contemporary renal biopsies are performed exclusively in a hospital setting followed by a reasonable interval of observation for post procedural complications. Here, we present the first study to evaluate ultrasound guided percutaneous renal core biopsy performed in the office setting. METHODS: This is a retrospective study involving 108 patients who underwent office based ultrasound guided percutaneous renal biopsy for the evaluation of a solid renal mass between April 2010 and October 2015. Baseline vital signs and ultrasound were performed prior to core biopsy. If the mass was deemed amenable to biopsy, patients underwent ultrasound guided biopsy by one of three urologic oncologists. Patients were observed for 1 hour after the procedure and repeat vital signs and ultrasound were performed. Hemodynamically stable patients without developing hematoma were discharged home with appropriate follow up. Descriptive statistics were performed. RESULTS: In the 108 patients (70% male, mean age 68 years), average mass size was 3.95cm. Biopsy yield was as follows: 72/108 (66.7%) Renal Cell Carcinoma (RCC), 11/108 (10.19%) Oncocytoma, 6/108 (5.56%) Angiomyolipoma, 2/108 (1.85%) Lymphoma, and 17/108 (15.74%) benign histology. The non-diagnostic rate leading to re-biopsy was 5.56%. 25.93% of patients were observed while 73.15% of patients went on to receive surgery or ablative therapy. Final pathology was concordant with biopsy results in 64/65 (98.4%) of cases. Only one patient experienced a grade one Clavien-Dindo surgical complication, which was a small perirenal hematoma, which was managed with analgesics and did not require hospitalization. CONCLUSIONS: Office based ultrasound guided renal core biopsy is potentially as safe and efficacious as standard hospital based CT guided biopsy. Additionally, ultrasound guided biopsy potentially offers improved dynamic characterization of SRM, greater convenience and availability to patients as well as tremendous overall cost savings.
PD46-11 ACTIVE SURVEILLANCE OF RENAL MASSES e THE MEMORIAL SLOAN-KETTERING EXPERIENCE Nick Liu*, Cheryn Song, Katie Murray, Alan Thong, Paul Russo, Jonathan Coleman, New York City, NY INTRODUCTION AND OBJECTIVES: Active surveillance is an accepted management of renal masses (RM) in appropriately selected patients. We describe the growth characteristics of renal mass under surveillance, identify factors associated with growth rate and evaluate associated outcomes in a large series of patients with competing morbidities. METHODS: From the institutional database, we identified 460 renal masses from 398 patients diagnosed between 1993 and 2013 followed radiographically for at least 12 months without definitive therapy. Maximal mass diameter was obtained from all images and individual growth rate obtained using slope of linear regression. Clinical factors were evaluated for their association with RM growth rate, interventions, pathologic and survival outcomes using linear and logistic regression as well as Cox proportional hazards model. RESULTS: Median patient age was 69 years (IQR 61, 75) and 84% had significant comorbidity including 33% with Charlson comorbidity index greater than 3. Median initial tumor size was 2cm (IQR 1.3, 3.0) and 70 RM (15%) were cT1b or greater tumors. Median RM growth rate was 0.15cm/year (IQR 0.01, 0.36). Presence of coexisting simple cyst in the ipsilateral kidney was independently associated with lower RM growth rate (B¼-0.15, 95%CI [-0.25, -0.05], p¼0.005). Management was altered to treatment in 178 (39%) RM after a median surveillance period of 34 months (IQR 19, 56). Patients with faster growth rate (OR: 5.6, 95%CI [2.9, 11]), younger age (OR: 0.95, 95%CI [0.92, 0.96]), and higher GFR (OR: 2.0, 95%CI [1.2, 3.4]) were more likely to undergo delayed treatment than continuing with surveillance. In the 219 (48%) RM with histologic diagnosis, cancer was identified in 88%. Compared to benign RM, malignant RM grew faster (0.3 vs. 0.08 cm/year, p¼0.001). At a median follow-up of 61 months (IQR 43, 100), 11 (3%) had metastatic RCC and 8 (2%) died of kidney cancer; 77 patients (19%) died of causes other than kidney cancer. On Cox regression, overall survival was negatively associated with patient age >75 and increasing
Source of Funding: None
PD46-12 OFFICE BASED ULTRASOUND GUIDED RENAL CORE BIOPSY IS SAFE AND EFFICACIOUS IN THE MANAGEMENT OF SMALL RENAL MASSES Chirag Dave*, Brian Seifman, Rene Frontera, Ryan Nelson, Heather Crossley, Travis Washington, Preston Kerr, Edward Schervish, Royal Oak, MI
Source of Funding: None