Presentation Authors: Ari P. Bernstein*, Meenakshi Davuluri, Alexander Sankin, Kara Watts, Ahmed Aboumohamed, Joshua M. Stern, Evan Kovac, Bronx, NY
Introduction: Patients with end stage renal disease (ESRD) and small renal masses (SRM) suspicious for renal cell carcinoma (RCC) are often urged to undergo radical nephrectomy (RN) prior to kidney transplant. However, is active surveillance (AS) underutilized in this population? We endeavored to compare clinicopathologic characteristics and outcomes of RN for SRM in patients with ESRD before or after transplant.
Methods: We performed a retrospective review of patients with ESRD (GFR < 15mL/min) who underwent RN for pathologically confirmed RCC between 2000-2018 at a high volume kidney transplant institution. Group 1 consisted of patients who underwent RN after transplant; Group 2 consisted of patients with ESRD who underwent RN, with or without subsequent transplant. Dominant tumor size and histopathologic characteristics, recurrence and survival outcomes were compared between groups. Chi-square and Mann-Whitney U tests were used to compare categorical and continuous baseline and histopathologic characteristics, respectively. Univariate analysis and log rank test were used to compare RCC recurrence rates between groups after RN.
Results: We identified 28 RN in 24 patients in group 1 and 70 RN in 61 patients in group 2. Median time from transplant to SRM radiologic diagnosis in group 1 was 87 months. Median time from radiologic SRM diagnosis to RN was 3 and 4 months for group 1 and 2, respectively. Baseline demographic, clinical and histopathologic features of both groups are depicted in Table 1. Demographic characteristics were similar between groups. There were no statistically significant differences between pathologic dominant mass size, histologic subtype breakdown, grade or stage between the groups. Median follow-up after RN was 40 and 43 months for groups 1 and 2, respectively. Univariate analysis did not reveal a statistically significant difference in recurrence-free survival between the groups (P=0.9). Two and 8 patients died in groups 1 and 2, respectively. One patient died of RCC and was from group 1.
Conclusions: Patients undergoing RN before or after transplant with malignant SRM have similar clinicopathologic characteristics and recurrence-free survival outcomes. Our results suggest that patients with ESRD and SRM need not delay transplant and AS may be a good first line option for many.