Presentation Authors: Maria Carmen Mir Maresma, Valencia, Spain, Michele Marchioni, Chiesti, Italy, Nicola Pavan, Trieste, Italy, Alessandro Antonelli, Brescia, Italy, Umberto Capitanio, Milan, Italy, Toshio Takagi, Tokyo, Japan, Ithaar Derweesh, San Diego, CA, Estefania Linares, Madrid, Spain, Koon Rha, Seoul, Korea, Democratic People's Republic of, Tobias Maurer, Munich, Germany, Alexandre Mottrie, Aalst, Belgium, Jean Alexandre Long, Grenoble, France, Maria Furlan, Brescia, Italy, Alessandro Larcher, Milan, Italy, Alberto Breda, Barcelona, Spain, Francesco Porpiglia, Turin, Italy, Cheaib Joseph*, Baltimore, MD, Juan Garisto, Clevealnd, OH, Wourter Everaerts, Steven Joniau, Leuven, Belgium, Jihad Kaouk, Cleveland, OH, Riccardo Autorino, Richmond, VA, Phillip Pierorazio, Baltimore, MD
Introduction: Choosing the optimal management strategy for the very elderly patients with small renal masses, continues to be debated. Aim of this study was to compare the outcomes of nephron sparing surgery (NSS) versus active surveillance (AS) in this patient population.
Methods: A purpose built multi-institutional international database (REnal SURGery in the Elderly - RESURGE project) was used for this retrospective analysis. Patients older than 75 years and presenting with a renal mass were treated between 2000 and 2016 at participating centers by NSS (i.e. partial nephrectomy or kidney ablation).A prospective registry of patients under AS for small renal mass (DISSRM) was also included in the analysis and used as comparative study group. A 1 to 2.2 matching was performed, which resulted in a total of 83 patients on AS and 186 on NSS. The variables included for matching were Clinical size, Charlson Comorbidity Index, presence of diabetes mellitus, hypertension and BMI and age. Cumulative incidence and competing risk regression were used to estimate OCM rates.
Results: Median follow-up was 34 months. Main descriptive characteristics are summarized on Table 1. Briefly, 50% of patients had tumors below 2 cm, 43% were older than 80 years old at diagnosis and over 70% had hypertension. At multivariate Cox Regression Analysis, patients undergoing NSS presented with lower rates of OCM (HR = 0.32; 95% CI (0.15-0.71); p = 0.045) and OM (HR = 0.41; 95% CI 0.21-0.83; p = 0.01) (Figure 1 KM Plot). On the cumulative incidence plot, a trend towards death by other cause was observed in both study groups
Conclusions: Within the limitations of this type of analysis, our findings suggest that both AS and NSS are viable treatment options for very elderly patients with SRM. Further studies are required to tailor the role of the different treatment option available.