813 INITIAL OBSERVATIONS OF THE DISSRM (DELAYED INTERVENTION AND SURVEILLANCE FOR SMALL RENAL MASSES) REGISTRY

Article Outline

• INTRODUCTION AND OBJECTIVES
• METHODS
• RESULTS
• CONCLUSIONS
• Copyright

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INTRODUCTION AND OBJECTIVES 

The DISSRM Registry was opened January 1, 2009, prospectively enrolling patients with small renal masses (SRM) 4.0 cm or less who chose intervention or active surveillance (AS) for their SRM.

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METHODS 

Following consultation with their primary urologist and after a decision was made regarding AS versus intervention patients were prospectively enrolled in the DISSRM Registry. Those undergoing intervention were followed at the discretion of the operating physician. Those electing AS were placed on an axial imaging protocol (CT or MRI) every 4 months for the first 2 years, every 6 months for the remaining 3 years. All patients completed the SF-12 quality-of-life questionnaire at enrollment; subsequent questionnaires are scheduled for 6, 12 months and annually thereafter.

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RESULTS 

As of 10 complete months, 111 patients were enrolled. 70 elected intervention; 38 AS; 6 crossed-over to intervention; 3 patients withdrew consent. Median age and mean tumor size in the AS and intervention arms were 72.5 and 61 years (p<0.001), and 2.02 and 2.39cm (p=0.01) respectively. 63 (56.7%) were men, 87 (78.4%) were Caucasian; there were no significant differences in sex or race between the groups. Mean SF12 score was similar between AS and intervention groups at enrollment (95.1 vs. 96.2, p=0.4); SF12 was significantly better for intervention at 6 months (100.7 vs. 92.2, p0.03). For those electing surgery, 46 (60.5%), 12 (15.8%) and 18 (23.7%) underwent partial nephrectomy (PN), radical nephrectomy and renal cryoablation respectively. 10 (13.5%) PN were performed open, 6 (8.1%) cryoablations were performed percutaneously; the remainder of cases were done laparoscopically. Of the treated masses, 51 were RCC. Of the 22 benign masses, 9 (12.3%) were oncocytoma, 4 (5.4%) were AML. Of the 20 patients who underwent surgery with a positive growth rate and the 7 patients with growth rates >0.5cm/year, pathology was RCC in 14 and 4 respectively. With a median follow-up of 5.7 months, there have been no recurrences, progressions or deaths.

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CONCLUSIONS 

With short term follow-up in a registry of patients with SRM, just over 60% selected intervention versus AS. Quality-of-life is significantly better at 6 months for those who undergo intervention. 70% of masses removed were malignant, however recurrence and progression free survival are excellent with short follow-up.