TY - JOUR
T1 - Evaluation of Growth Rates for Small Renal Masses in Elderly Patients Undergoing Active Surveillance
AU - Alam, Ridwan
AU - Yerrapragada, Anirudh
AU - Wlajnitz, Tina
AU - Watts, Emelia
AU - Pallauf, Maximilian
AU - Enikeev, Dmitry
AU - Chang, Peter
AU - Wagner, Andrew A.
AU - McKiernan, James M.
AU - Pierorazio, Phillip M.
AU - Allaf, Mohamad E.
AU - Singla, Nirmish
N1 - Publisher Copyright:
© 2023 The Author(s)
PY - 2023/4
Y1 - 2023/4
N2 - Background: As the adoption of active surveillance (AS) for small renal masses (SRMs) grows, the number of elderly patients enrolled for a prolonged period of time will increase. However, our understanding of comparative growth rates (GRs) in aging patients with SRMs remains poor. Objective: To examine whether particular age cutoffs are associated with an increased GR for patients undergoing AS for SRMs. Design, setting, and participants: We identified all patients with SRMs enrolled in the multi-institutional, prospective Delayed Intervention and Surveillance for Small Renal Masses (DISSRM) registry since 2009 who elected for AS. Outcome measurements and statistical analysis: Two definitions of GR were examined: GR from the initial image (GRi) and GR from the prior image (GRp). Image measurements were dichotomized based on patient age at the time of imaging. Multiple age cutoffs were examined: 65, 70, 75, and 80 yr. Mixed-effect linear regression examined the associations between age and GR, with controlling to account for multiple measurements from the same individual. Results and limitations: We examined 2542 measurements from 571 patients. The median age at enrollment was 70.9 yr (interquartile range [IQR] 63.2–77.4) with a median tumor diameter of 1.8 cm (IQR 1.4–2.5). As a continuous variable, age was not associated with GRi (–0.0001 cm/yr, 95% confidence interval [CI] –0.007 to 0.007, p = 0.97) or GRp (0.008 cm/yr, 95% CI –0.004 to 0.020, p = 0.17) after adjustment. The only age thresholds associated with an increased GR were 65 yr for GRi and 70 yr for GRp. Limitations include the one-dimensional nature of the measurements used. Conclusions: Increased age for patients on AS for SRMs is not associated with increased GRs. Patient summary: We examined whether patients undergoing active surveillance (AS) exhibited accelerated growth of their small renal masses (SRMs) after a certain age. No demonstrable change was seen, suggesting that AS is a safe and durable management option for aging patients with SRMs.
AB - Background: As the adoption of active surveillance (AS) for small renal masses (SRMs) grows, the number of elderly patients enrolled for a prolonged period of time will increase. However, our understanding of comparative growth rates (GRs) in aging patients with SRMs remains poor. Objective: To examine whether particular age cutoffs are associated with an increased GR for patients undergoing AS for SRMs. Design, setting, and participants: We identified all patients with SRMs enrolled in the multi-institutional, prospective Delayed Intervention and Surveillance for Small Renal Masses (DISSRM) registry since 2009 who elected for AS. Outcome measurements and statistical analysis: Two definitions of GR were examined: GR from the initial image (GRi) and GR from the prior image (GRp). Image measurements were dichotomized based on patient age at the time of imaging. Multiple age cutoffs were examined: 65, 70, 75, and 80 yr. Mixed-effect linear regression examined the associations between age and GR, with controlling to account for multiple measurements from the same individual. Results and limitations: We examined 2542 measurements from 571 patients. The median age at enrollment was 70.9 yr (interquartile range [IQR] 63.2–77.4) with a median tumor diameter of 1.8 cm (IQR 1.4–2.5). As a continuous variable, age was not associated with GRi (–0.0001 cm/yr, 95% confidence interval [CI] –0.007 to 0.007, p = 0.97) or GRp (0.008 cm/yr, 95% CI –0.004 to 0.020, p = 0.17) after adjustment. The only age thresholds associated with an increased GR were 65 yr for GRi and 70 yr for GRp. Limitations include the one-dimensional nature of the measurements used. Conclusions: Increased age for patients on AS for SRMs is not associated with increased GRs. Patient summary: We examined whether patients undergoing active surveillance (AS) exhibited accelerated growth of their small renal masses (SRMs) after a certain age. No demonstrable change was seen, suggesting that AS is a safe and durable management option for aging patients with SRMs.
KW - Active surveillance
KW - Age
KW - Geriatrics
KW - Natural history
KW - Small renal mass
KW - Tumor growth
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U2 - 10.1016/j.euros.2023.02.004
DO - 10.1016/j.euros.2023.02.004
M3 - Article
C2 - 37101773
AN - SCOPUS:85149805496
SN - 2666-1691
VL - 50
SP - 78
EP - 84
JO - European Urology Open Science
JF - European Urology Open Science
ER -