Determinants of Active Surveillance in Patients With Small Renal Masses

Nguyen, Kevin A.; Nolte, Adam; Alimi, Oriyomi; Hsiang, Walter; Lu, Amanda; Ghabili, Kamyar; Syed, Jamil; Suarez‐Sarmiento, Alfredo; Perecman, Aaron; Shuch, Brian; Leapman, Michael

doi:10.1016/j.urology.2018.07.021

Cited by 16 publications

(12 citation statements)

References 26 publications

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“…Variability was seen in the utilization of OB among practices; however, no obvious factors seemed to attribute to this variability. A prior NCDB study [15] had reported academic setting being a factor in increased OB; however, this was not seen in our study, with no difference observed on multivariate analysis. Owing to a small number of cases (<20) in seven practices, further analysis per practice could not be performed at this time.…”

Section: Discussioncontrasting

confidence: 99%

“…This is, in part, based on the long-term oncologic outcomes seen in a growing number of single-institutional series and evidence indicating the safety of AS up to 10 yr in duration in select centers [7] , [20] , [21] . Rates of AS have been reported to be in the range of 2.9–30% in prior population-based studies [13] , [15] , [16] , [22] , which are significantly lower than the 46% AS rate demonstrated in this study. We observed significant variability in the use of OB (rates: 0–68%) within the 13 practices participating in MUSIC-KIDNEY.…”

Section: Discussioncontrasting

confidence: 79%

“…There are several notable findings from our analysis regarding the utilization of OB within our collaborative. The patient factor most strongly associated with OB was older age, as has been shown in several other studies [14] , [15] . Of note, there was no association between medical comorbidity or baseline renal function and choice of OB, despite prior reports indicating that those with comorbid illnesses have competing mortality risks [9] , [11] .…”

Section: Discussionsupporting

confidence: 77%

“…Understanding the current utilization of AS for cT1aRMs or cT1RMs is difficult, with an analysis of large national datasets such as the National Cancer Database (NCDB) and the Surveillance, Epidemiology and End Results (SEER)-Medicare database reporting AS utilization from 2.7% to 30% [13] , [14] , [15] , [16] . These may not reflect current management, given the limitations of under-reporting [17] and completeness with geographic, ethnic, and age variation and disease site [18] .…”

Section: Introductionmentioning

confidence: 99%

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Initial Observation of a Large Proportion of Patients Presenting with Clinical Stage T1 Renal Masses: Results from the MUSIC-KIDNEY Statewide Collaborative

Patel

Rogers

Johnson

et al. 2021

European Urology Open Science

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Background While surgical excision remains the principal management strategy for clinical T1 renal masses (cT1RMs), the rates of noninterventional approaches are not well known. Most single-institution and population-based series suggest rates below 10%. Objective To evaluate the use of observation for newly diagnosed cT1RM patients in academic and community-based practices across a statewide collaborative. Design, setting, and participants The Michigan Urological Surgery Improvement Collaborative—Kidney mass: Identifying and Defining Necessary Evaluation and therapY (MUSIC-KIDNEY) commenced data collection in September 2017 by recording clinical, radiographic, pathologic, and short-term follow-up data for cT1RM patients at 13 diverse practices. Patients with complete data were assessed at >90 d after initial evaluation as to whether observation or treatment was performed. Outcome measurements and statistical analysis Relationships with outcomes were analyzed using multivariable logistic regression, chi-square test, and Wilcoxon rank-sum test. Results and limitations Out of 965 patients, observation was employed in 48% ( n = 459), with practice-level rates ranging from 0% to 68%. Patients managed with observation (vs treatment) were significantly older (71.2 vs 62.8 yr, p < 0.0001) and had smaller tumors (2.3 vs 3.4 cm, p < 0.0001). Observation was used for 53.5% of cT1a renal masses, for 29.9% of cT1b renal masses, and for 42.5%, 53.7%, and 63.9% of radiographically solid, Bosniak III–IV cystic, and indeterminate cT1RMs, respectively. Factors significantly associated with observation in multivariable analysis included lesion type (Bosniak III–IV vs solid, p = 0.017), tumor stage (cT1a vs cT1b, p < 0.001), and higher age ( p < 0.001). A short duration of follow-up limits the assessment of longer-term patient management. Conclusions Noninterventional management of cT1RMs is common across the MUSIC-KIDNEY collaborative, with wide variability across practices. Factors associated with observation were advanced age, smaller tumor size, and cystic tumor type. Durability of the initial decision for observation (delayed intervention vs active surveillance vs less active surveillance) will be a focus of subsequent study. Patient summary The Michigan Urological Surgery Improvement Collaborative: Kidney mass: Identifying and Defining Necessary Evaluation and therapY (MUSIC-KIDNEY) quality improvement collaborative assessed the current utilization of initial observation of a renal mass ≤7 cm across a diverse group of urology practices and found it to be used in 48% of patients. We found that the factors predicting observation were advanced age, smaller tumor size, and cystic ...

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Section: Discussioncontrasting

confidence: 99%

Section: Discussioncontrasting

confidence: 79%

Section: Discussionsupporting

confidence: 77%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Initial Observation of a Large Proportion of Patients Presenting with Clinical Stage T1 Renal Masses: Results from the MUSIC-KIDNEY Statewide Collaborative

Patel

Rogers

Johnson

et al. 2021

European Urology Open Science

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show abstract

“…Moreover, initial active surveillance can also help in identifying tumors with worrisome growth and in guiding selection for definitive treatment. Clearly, active surveillance-the ultimate nephron-sparing approach-remains underutilized [9].…”

Section: Underutilization Of Active Surveillancementioning

confidence: 99%

The Harms of Overdiagnosis and Overtreatment in Patients with Small Renal Masses: A Mini-review

Sohlberg

Metzner

Leppert

2019

European Urology Focus

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Racial/ethnic disparities in renal cell carcinoma: Increased risk of early‐onset and variation in histologic subtypes

et al. 2019

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Background Racial/ethnic minority groups have a higher burden of renal cell carcinoma (RCC), but RCC among Hispanic Americans (HAs) and American Indians and Alaska Natives (AIs/ANs) are clinically not well characterized. We explored variations in age at diagnosis and frequencies of RCC histologic subtypes across racial/ethnic groups and Hispanic subgroups using National Cancer Database (NCDB) and Arizona Cancer Registry Data. Methods Adult RCC cases with known race/ethnicity were included. Logistic regression analysis was performed to estimate odds and 95% confidence interval (CI) of early‐onset (age at diagnosis <50 years) and diagnosis with clear cell RCC (ccRCC) or papillary RCC. Results A total of 405 073 RCC cases from NCDB and 9751 cases from ACR were identified and included. In both datasets, patients from racial/ethnic minority groups had a younger age at diagnosis than non‐Hispanic White (NHW) patients. In the NCDB, AIs/ANs had twofold increased odds (OR, 2.21; 95% CI, 1.88‐2.59) of early‐onset RCC compared with NHWs. HAs also had twofold increased odds of early‐onset RCC (OR, 2.14; 95% CI, 1.79‐2.55) in the ACR. In NCDB, ccRCC was more prevalent in AIs (86.3%) and Mexican Americans (83.5%) than NHWs (72.5%). AIs/ANs had twofold increased odds of diagnosis with ccRCC (OR, 2.18; 95% CI, 1.85‐2.58) in the NCDB, but the association was stronger in the ACR (OR, 2.83; 95% CI, 2.08‐3.85). Similarly, Mexican Americans had significantly increased odds of diagnosis with ccRCC (OR, 2.00; 95% CI, 1.78‐2.23) in the NCDB. Conclusions This study reports younger age at diagnosis and higher frequencies of ccRCC histologic subtype in AIs/ANs and Hispanic subgroups. These variations across racial/ethnic groups and Hispanic subgroups may have potential clinical implications.

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Determinants of Active Surveillance in Patients With Small Renal Masses

Cited by 16 publications

References 26 publications

Initial Observation of a Large Proportion of Patients Presenting with Clinical Stage T1 Renal Masses: Results from the MUSIC-KIDNEY Statewide Collaborative

Initial Observation of a Large Proportion of Patients Presenting with Clinical Stage T1 Renal Masses: Results from the MUSIC-KIDNEY Statewide Collaborative

The Harms of Overdiagnosis and Overtreatment in Patients with Small Renal Masses: A Mini-review

Racial/ethnic disparities in renal cell carcinoma: Increased risk of early‐onset and variation in histologic subtypes

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