Tumor Anatomy Scoring and Renal Function for Nephron-Sparing Treatment Selection in Patients With Small Renal Masses: A Microsimulation-Based Decision Analysis

Abstract

Nephron-sparing treatment selection for small renal masses based on nephrometry score may improve LE in patients with mild or moderate CKD.

Personalized Treatment for Small Renal Tumors: Decision Analysis of Competing Causes of Mortality

“…heterogeneous patient population, we constructed a decisionanalytic model to synthesize the evidence and compare a number of strategies. The simulated population included variable severity of CKD, comorbidity status, and tumors with variable malignant potential and anatomic complexity as a risk factor (21). Partial nephrectomy is selected for patients with normal renal function, and for stage 2 or 3a chronic kidney disease and nephrometry score of 6 or less; otherwise, percutaneous ablation is used.…”

“…to collecting system or sinus, anterior/ posterior, location relative to polar lines (referred to as RENAL) nephrometry score (NS), which has been shown to predict parenchymal and functional loss after PN (27)(28)(29). Technical details of modeling renal functional decline and CKD-related mortality risks were described previously (21), and included model construction, calibration, and validation; this preparatory study involved simulated combinations of tumor NSs and CKD stages to identify whether the more effective nephronsparing treatment option was PN or percutaneous thermal ablation (21). The favored nephron-sparing therapy was then incorporated into all personalized treatment strategies for the current model (Fig 1).…”

“…CT-based active surveillance with nephron-sparing treatment for growing lesions; and (e) active surveillance for presumed papillary RCC on the basis of contrast agent-enhanced MRI, with nephron-sparing treatment for all other tumors. For strategies b-e, the selection of nephron-sparing treatment (PN or ablation) was on the basis of whether PN or percutaneous ablation was favorable for the CKD stage and NS (21).…”

“…ReAFFIRM results of life expectancy were validated against independent sources of cancer-specific and overall survival not used in the model, including a prospective registry of patients undergoing active surveillance (46), and a retrospective analysis of cancer-specific and overall mortality in patients treated for localized RCC (65). Additional validation methods specific to modeling survival with CKD were previously reported (21).…”

“…Decision-analytic modeling has been used to compare treatment strategies for numerous conditions wherever trial data are not available or do not allow for direct comparisons of interventions (18)(19)(20). Given the lack of randomized trial data to date regarding partial nephrectomy (PN) versus active surveillance, and the need for guidance on how surveillance can be designed to balance benefits and harms for a 733 for postoperative renal functional decline (21). Our purpose was to compare the effectiveness of personalized treatment for small (4 cm) renal tumors versus routine PN by accounting for various competing causes of mortality.…”