Is active surveillance as safe of a long-term treatment plan as partial nephrectomy for small renal masses in “real-world” practice? - An OCM-matched analysis
Recommended Citation
Cusmano NB, Bertini A, Finocchiaro A, Vigano S, Stephens A, Dinesh A, Guivatchian E, Mssika A, Lughezzani G, Buffi N, Ficarra V, Salonia A, Di Trapani E, Rogers C, Abdollah F. Is active surveillance as safe of a long-term treatment plan as partial nephrectomy for small renal masses in “real-world” practice? - An OCM-matched analysis. Eur Urol 2025; 87(S1):1160.
Document Type
Conference Proceeding
Publication Date
3-1-2025
Publication Title
Eur Urol
Abstract
Introduction & Objectives: Active surveillance (AS) is now an accepted treatment option for small renal masses (SRM). This is largely based on rigorous trial results, where patients are under strict surveillance protocols. However, in “real-world” practice, AS patients might not be compliant or receive such strict protocols, which ultimately could be detrimental to their outcomes. Currently, there is limited population-based data regarding the outcomes of AS with SRMs. Moreover, what is available is biased by clinical selection, where “sicker” patients are more frequently treated with AS. To circumvent these limitations, we aim to evaluate the impact of AS vs partial nephrectomy (PN) on long term CSM in a population based OCM-matched cohort. Materials & Methods: The Surveillance, Epidemiology, and End Results (SEER) database was queried for individuals diagnosed with a SRM less than 3 cm between 2004-2017. Patients were stratified into AS and PN depending on treatment decision within a year of diagnosis, excluding those that underwent radical nephrectomy. A Cox regression model was used to calculate the OCM risk with all available covariates, including treatment type. Then, a 1:1 propensity score-matched cohort was created based on the calculated OCM risk. Once matched, a cumulative incidence function (CIF) was used to estimate CSM rates for treatment comparison. Competing risk regression tested the impact of treatment on CSM, after accounting for all available covariates. Results: We identified 8313 patients in total with a median follow-up time of 7.8 years (IQR 5.5-10.9). The cohort was mainly White (82.4%) with a median age of 63 (IQR 59-68) and a median tumor size of 2.2 cm (IQR 1.7-2.6). After matching based on calculated 5-yr OCM risk, each new group contained 298 patients, and no significant difference was found in OCM between AS and PN (10-yr OCM 30.1% vs 28.6% p=.7), indicating a strong match. The 10-yr CSM rate was 5.6% vs 2.9% in patients undergoing AS vs PN (p=0.2). Multivariable analysis confirmed treatment type to not be an independent predictor of CSM risk (HR: 1.82, 95% CI 0.76-4.36, p=0.1). Conclusions: By successfully accounting for clinical selection bias, our study has demonstrated that pursuing active surveillance does not confer a survival disadvantage for SRMs in the long-term. These results, along with shared decision making, can help prevent surgical over-treatment, while the need for a standardized SRM protocol remains.
Volume
87
Issue
S1
First Page
1160
