Evaluation of Growth Rates for Small Renal Masses in Elderly Patients Undergoing Active Surveillance

Ridwan Alam; Anirudh Yerrapragada; Tina Wlajnitz; Emelia Watts; Maximilian Pallauf; Dmitry Enikeev; Peter Chang; Andrew A Wagner; James M McKiernan; Phillip M Pierorazio; Mohamad E Allaf; Nirmish Singla

doi:10.1016/j.euros.2023.02.004

Evaluation of Growth Rates for Small Renal Masses in Elderly Patients Undergoing Active Surveillance

Ridwan Alam, Anirudh Yerrapragada, Tina Wlajnitz, Emelia Watts, Maximilian Pallauf (Co-author), Dmitry Enikeev, Peter Chang, Andrew A Wagner, James M McKiernan, Phillip M Pierorazio, Mohamad E Allaf, Nirmish Singla

Research output: Contribution to journal › Original Article › peer-review

Abstract

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 (GR i) and GR from the prior image (GR p). 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 GR i (-0.0001 cm/yr, 95% confidence interval [CI] -0.007 to 0.007, p = 0.97) or GR p (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 GR i and 70 yr for GR p. 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.

Original language	English
Pages (from-to)	78-84
Number of pages	7
Journal	EUROPEAN UROLOGY OPEN SCIENCE
Volume	50
DOIs	https://doi.org/10.1016/j.euros.2023.02.004
Publication status	Published - Apr 2023
Externally published	Yes

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10.1016/j.euros.2023.02.004

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@article{3033cf983ba6412cb1a4cc2ba127d1fb,

title = "Evaluation of Growth Rates for Small Renal Masses in Elderly Patients Undergoing Active Surveillance",

abstract = "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 (GR i) and GR from the prior image (GR p). 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 GR i (-0.0001 cm/yr, 95\% confidence interval [CI] -0.007 to 0.007, p = 0.97) or GR p (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 GR i and 70 yr for GR p. 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.",

author = "Ridwan Alam and Anirudh Yerrapragada and Tina Wlajnitz and Emelia Watts and Maximilian Pallauf and Dmitry Enikeev and Peter Chang and Wagner, \{Andrew A\} and McKiernan, \{James M\} and Pierorazio, \{Phillip M\} and Allaf, \{Mohamad E\} and Nirmish Singla",

note = "Pallauf: nur externe Aff.",

year = "2023",

month = apr,

doi = "10.1016/j.euros.2023.02.004",

language = "English",

volume = "50",

pages = "78--84",

journal = "EUROPEAN UROLOGY OPEN SCIENCE",

issn = "2666-1691",

}

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 - Pallauf: nur externe Aff.

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 (GR i) and GR from the prior image (GR p). 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 GR i (-0.0001 cm/yr, 95% confidence interval [CI] -0.007 to 0.007, p = 0.97) or GR p (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 GR i and 70 yr for GR p. 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 (GR i) and GR from the prior image (GR p). 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 GR i (-0.0001 cm/yr, 95% confidence interval [CI] -0.007 to 0.007, p = 0.97) or GR p (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 GR i and 70 yr for GR p. 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.

U2 - 10.1016/j.euros.2023.02.004

DO - 10.1016/j.euros.2023.02.004

M3 - Original Article

C2 - 37101773

SN - 2666-1691

VL - 50

SP - 78

EP - 84

JO - EUROPEAN UROLOGY OPEN SCIENCE

JF - EUROPEAN UROLOGY OPEN SCIENCE

ER -

Evaluation of Growth Rates for Small Renal Masses in Elderly Patients Undergoing Active Surveillance

Abstract

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