Active surveillance for small renal masses in elderly patients does not increase overall mortality rates compared to primary intervention: a propensity score weighted analysis

Michele Marchioni, Joseph G. Cheaib, Toshio Takagi, Nicola Pavan, Alessandro Antonelli, Wourter Everaerts, Matthias Heck, Koon H. Rha, Alexandre Mottrie, Jihad Kaouk, Umberto Capitanio, Estevão Lima, Alessandro Veccia, Simone Crivellaro, Estefania Linares, Antonio Celia, Francesco Porpiglia, Riccardo Autorino, Marta Di Nicola, Luigi SchipsPhillip M. Pierorazio, Maria Carmen Mir

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Abstract

BACKGROUND: The aim of the study was to test the effect of active surveillance (AS) versus primary intervention (PI) on overall mortality (OM) in elderly patients diagnosed with SRM. METHODS: Elderly patients (75 years or older) diagnosed with SRMs (<4 cm) and treated with either PI (i.e. partial nephrectomy or kidney ablation) or AS between 2009 and 2018 were abstracted from the renal surgery in the elderly (RESURGE) and Delayed Intervention and Surveillance for small Renal Masses (DISSRM) datasets, respectively. OM rates were estimated among groups with Kaplan Meier method and Cox proportional hazards regression models after applying inverse probability of treatment weighting (IPTW). Multivariable logistic regression model was used to estimate IPTW. Covariates of interest were those unbalanced and/or significantly correlated with the treatment choice or with OM. RESULTS: A total of 483 patients were included; 121 (25.1%) underwent AS. Sixty patients (12.4%) died. Overall, 6.7% of all deaths were related to cancer. IPTW-Kaplan Meier curves showed a 5-year overall survival rates of 70.0±3.5% and 73.2±4.8% in AS and PI groups, respectively (IPTW-Log-rank P value=0.308). IPTW-Cox regression model did not show meaningfully increased OM rates in AS group (HR: 1.31, 95% CI: 0.69-2.49). CONCLUSIONS: AS represents an appealing treatment option for very elderly patients presenting with SRM, as it avoids the risks of a PI while not compromising the survival outcomes of these patients.

Original languageEnglish
Pages (from-to)781-788
Number of pages8
JournalMinerva Urology and Nephrology
Volume73
Issue number6
DOIs
Publication statusPublished - 2022

Bibliographical note

Publisher Copyright:
© 2020 EDIZIONI MINERVA MEDICA.

All Science Journal Classification (ASJC) codes

  • Nephrology
  • Urology
  • Medicine(all)

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