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Selecting Patients with Small Renal Masses for Active Surveillance: A Domain Based Score from a Prospective Cohort Study

2019; Lippincott Williams & Wilkins; Volume: 201; Issue: 5 Linguagem: Inglês

10.1097/ju.0000000000000033

1527-3792

Ayodeji E. Sotimehin, Hiten D. Patel, Ridwan Alam, Michael A. Gorin, Michael H. Johnson, Peter Chang, Andrew A. Wagner, James M. McKiernan, Mohamad E. Allaf, Phillip M. Pierorazio,

Renal cell carcinoma treatment

No AccessJournal of UrologyAdult Urology1 May 2019Selecting Patients with Small Renal Masses for Active Surveillance: A Domain Based Score from a Prospective Cohort Studyis corrected byERRATUM Ayodeji E. Sotimehin, Hiten D. Patel, Ridwan Alam, Michael A. Gorin, Michael H. Johnson, Peter Chang, Andrew A. Wagner, James M. McKiernan, Mohamad E. Allaf, and Phillip M. Pierorazio Ayodeji E. SotimehinAyodeji E. Sotimehin *Correspondence: 600 North Wolfe St., Park Building, Room 217, Baltimore, Maryland 21287 (telephone: 678-640-7071; FAX: 410-502-7711; e-mail: E-mail Address: [email protected]). The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, Maryland More articles by this author , Hiten D. PatelHiten D. Patel The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, Maryland More articles by this author , Ridwan AlamRidwan Alam The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, Maryland More articles by this author , Michael A. GorinMichael A. Gorin The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, Maryland More articles by this author , Michael H. JohnsonMichael H. Johnson The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, Maryland More articles by this author , Peter ChangPeter Chang Division of Urology, Beth Israel Deaconess Medical Center, Boston, Massachusetts More articles by this author , Andrew A. WagnerAndrew A. Wagner Division of Urology, Beth Israel Deaconess Medical Center, Boston, Massachusetts More articles by this author , James M. McKiernanJames M. McKiernan Department of Urology, Columbia University Medical Center, New York, New York More articles by this author , Mohamad E. AllafMohamad E. Allaf The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, Maryland More articles by this author , and Phillip M. PierorazioPhillip M. Pierorazio The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, Maryland More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000033AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We sought to identify predictors of active surveillance in a prospective cohort study of patients with a small renal mass demonstrating favorable outcomes. We generated a summary score to discriminate patients selected for active surveillance or primary intervention. Materials and Methods: We analyzed the records of 751 patients from 2009 to 2018 who were enrolled in the DISSRM (Delayed Intervention and Surveillance for Small Renal Masses) Registry to compare active surveillance and primary intervention in the domains of demographics, tumor characteristics, comorbidity and patient reported quality of life. Regression models were created to assess univariable and multivariable model discrimination by the AUC and quality by the AIC (Akaike information criterion). The DISSRM score was based on the most predictive combination of variables and validated for its association with overall survival by Kaplan-Meier survival curves and a Cox proportional hazards regression model. Results: Of the patients 410 (55%) elected active surveillance and 341 (45%) elected primary intervention. Of the domains patient age, the Charlson comorbidity index, tumor diameter and the SF-12® Physical Component Score had the greatest discrimination for clinical selection into active surveillance. These domains made up the DISSRM score (AUC 0.801). The maximum DISSRM score was 7. The average score for active surveillance was 4.19 (median 4, IQR 2–6) and 72% of scores were 4 or greater. The average score for primary intervention was 3.03 (median 3, IQR 1–5) and 63% of scores were 3 or less. A higher DISSRM score was associated with worse overall survival, for example a score of 6-7 had a HR of 10.45 (95% CI 1.25–87.49, p = 0.03). Conclusions: The DISSRM score represents a measure of oncologic and competing risks of death in various important domains in patients with a small renal mass. It could be used to guide the management selection. 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No direct or indirect commercial, personal, academic, political, religious or ethical incentive is associated with publishing this article. © 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited bySu Z, Patel H, Huang M, Alam R, Cheaib J, Pavlovich C, Allaf M and Pierorazio P (2022) Active Surveillance versus Immediate Intervention for Small Renal Masses: A Cost-Effectiveness and Clinical Decision AnalysisJournal of Urology, VOL. 208, NO. 4, (794-803), Online publication date: 1-Oct-2022.Mendhiratta N, Sharma V, Wu J, Valdez T, Patel N, Gottsleben D, Battle D, Saigal C and Shuch B (2021) Decisional Regret and Financial Toxicity among Patients with Benign Renal MassesUrology Practice, VOL. 9, NO. 1, (32-39), Online publication date: 1-Jan-2022.Peabody H, Patel A, Johnson A, Mirza M, Noyes S, Schervish E, Kaul S, Rogers C, Lane B and Semerjian A (2020) Development of a Novel Scoring System Quantifies Opportunities to Reduce Surgery for Benign Renal Neoplasms: A Retrospective Quality Improvement Analysis within the MUSIC-KIDNEY CollaborativeJournal of Urology, VOL. 204, NO. 6, (1160-1165), Online publication date: 1-Dec-2020.Noyes S, Kim T, Johnson A, Linsell S, Qi J, Moldovan T, Patel A, Ghani K, Montie J, Rogers C and Lane B (2020) Quality of Care for Renal Masses: The Michigan Urological Surgery Improvement Collaborative—Kidney Mass: Identifying & Defining Necessary Evaluation & Therapy (MUSIC-KIDNEY)Urology Practice, VOL. 7, NO. 6, (507-514), Online publication date: 1-Nov-2020.Related articlesJournal of Urology9 Oct 2019ERRATUM Volume 201Issue 5May 2019Page: 886-892Supplementary Materials Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.Keywordskidney;renal cellrisk assessmentwatchful waitingcarcinomamortalityMetricsAuthor Information Ayodeji E. Sotimehin The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, Maryland *Correspondence: 600 North Wolfe St., Park Building, Room 217, Baltimore, Maryland 21287 (telephone: 678-640-7071; FAX: 410-502-7711; e-mail: E-mail Address: [email protected]). More articles by this author Hiten D. Patel The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, Maryland More articles by this author Ridwan Alam The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, Maryland More articles by this author Michael A. Gorin The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, Maryland More articles by this author Michael H. Johnson The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, Maryland More articles by this author Peter Chang Division of Urology, Beth Israel Deaconess Medical Center, Boston, Massachusetts More articles by this author Andrew A. Wagner Division of Urology, Beth Israel Deaconess Medical Center, Boston, Massachusetts More articles by this author James M. McKiernan Department of Urology, Columbia University Medical Center, New York, New York More articles by this author Mohamad E. Allaf The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, Maryland More articles by this author Phillip M. Pierorazio The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, Maryland More articles by this author Expand All The corresponding author certifies that, when applicable, a statement(s) has been included in the manuscript documenting institutional review board, ethics committee or ethical review board study approval; principles of Helsinki Declaration were followed in lieu of formal ethics committee approval; institutional animal care and use committee approval; all human subjects provided written informed consent with guarantees of confidentiality; IRB approved protocol number; animal approved project number. No direct or indirect commercial, personal, academic, political, religious or ethical incentive is associated with publishing this article. Advertisement PDF downloadLoading ...