Active Surveillance Versus Primary Intervention for Small Renal Masses

Active surveillance is not inferior to primary intervention for patients with small renal masses suspicious for renal cell carcinoma (RCC), according to new research presented at the American Urological Association 2023 Annual Meeting.

For clinical stage T1a renal masses, active surveillance is considered an alternative to primary intervention. However, there is a paucity of prospective data to support the use of active surveillance in patients with T1a renal masses, and active surveillance remains underutilized.

Khalid Y. Alkhatib, MD, MMSc, and colleagues assessed mature outcomes after a 12-year experience with the Delayed Intervention and Surveillance for Small Renal Masses registry, which prospectively enrolled 964 patients between 2009 to 2021 and allowed the choice to either undergo active surveillance or primary intervention. The prospective comparative study measured cancer-specific survival (CSS), overall survival (OS), progression-free survival (PFS), and recurrence-free survival (RFS).

Researchers noted that among the 785 patients with available follow-up data, 60.68% (n=585) elected active surveillance and 39.32% (n=379) chose primary intervention. They added that 15.04% (n=88) of active surveillance patients ultimately crossed over to delayed intervention.

After a median follow-up of 3.39 years, researchers reported no difference in CSS between the patient cohorts (P=.6), though active surveillance patients demonstrated worse OS compared with primary intervention patients (P<.001). Additionally, researchers reported no difference in RFS between the patient cohorts (P=.7).

In the active surveillance cohort, PFS was 62.1% at 7 years, and 76.4% of progressions were due to a growth rate of greater than 0.5 cm per year.

Unadjusted analysis demonstrated active surveillance was associated with increased all-cause mortality, and differences in all-cause mortality between the patient cohorts were attributable to increased age and Charlson Comorbidity Index in the active surveillance group (P=.02).

“Active surveillance is not inferior to primary intervention for carefully selected patients with small renal mass[es] suspicious for RCC,” study authors concluded, noting that “a priori definitions of progression, including growth rate, should be reconsidered given high rates of progression with few adverse oncologic outcomes.”