主动监测局部肾肿块的持久性：密歇根泌尿外科改进合作的3年结果

IF 4.5 3区医学 Q1 UROLOGY & NEPHROLOGY

European Urology Open Science Pub Date : 2025-03-26 DOI:10.1016/j.euros.2025.02.005

Yuzhi Wang , Samantha Wilder , Monica Van Til , Mackenzie Gammons , Mahin Mirza , Sabrina L. Noyes , Mohammad Jafri , Brian Seifman , Khurshid R. Ghani , Alice Semerjian , Craig G. Rogers , Brian R. Lane , for the Michigan Urological Surgery Improvement Collaborative

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引用次数: 0

摘要

背景与目的在密歇根州，约50%的≤7 cm的局部肾肿块（cT1RMs）患者没有立即干预，这与之前报道的10-20%的主动监测（AS）率相矛盾。当应用如此广泛时，关于AS的耐久性的问题仍然存在。我们评估了患者在AS发病后1年、2年和3年的肿瘤预后，包括生存率和延迟干预率，假设这些将与之前的报告相当。方法回顾2017年5月至2023年9月期间，在密歇根泌尿外科改进协作（MUSIC）实践中启动AS的2161例ct1rm患者（4178例中的52%）的数据。分析与停留AS相关的因素。使用Kaplan-Meier法评估总生存期和累积治疗发生率。21例临床共2161例患者发生AS，其中肿瘤≤2cm占51%，2.1-3.0 cm占26%，3.1-7.0 cm占24%。36个月时，总生存率为90%，只有1名拒绝干预的患者发生肾癌转移和死亡。1年、2年和3年的累积发病率分别为6%、11%和13%，≤2cm的肿瘤3年的累积发病率为9.6%,2.1-3.0 cm的为16%，>； 3cm的为18%。局限性包括该研究对前瞻性入组数据的回顾性审查限制了超过3年随访的结论。结论和临床意义：在usic实践中，50%的患者在3年内延迟干预发生率为13%，转移发生率为1%，这表明对于许多cT1RMs患者来说，AS是一种安全和持久的选择。有必要进一步研究AS的成像方案和长期预后。在密歇根州，大多数被诊断为4厘米的局部肾肿块和一些肿瘤高达7厘米的患者选择主动监测（AS），在发现后3年内进行干预的累积发生率为13%。在开始AS治疗3年后，该队列的总生存率为90%，癌症特异性生存率为99%，表明AS是一种安全持久的治疗策略。

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Durability of Active Surveillance for Localized Renal Masses: 3-year Outcomes in the Michigan Urological Surgery Improvement Collaborative

Background and objective

In Michigan, around 50% of patients with localized renal masses of ≤7 cm (cT1RMs) are managed without immediate intervention, contradicting previous reports indicating active surveillance (AS) rates of <10–20%. Questions remain regarding the durability of AS when applied so broadly. We evaluated the oncologic outcomes of patients at 1, 2, and 3 yr after the initiation of AS, including survival and delayed intervention rates, hypothesizing that these will be comparable to prior reports.

Methods

Between May 2017 and September 2023, data regarding 2161 (52% of 4178) patients with cT1RMs who initiated AS at Michigan Urological Surgery Improvement Collaborative (MUSIC) practices were reviewed. Factors associated with staying on AS were analyzed. Overall survival and the cumulative incidence of treatment were assessed using the Kaplan-Meier method.

Key findings and limitations

In total, 2161 patients from 21 practices initiated AS, including 51% with tumors of ≤2 cm, 26% with tumors of 2.1–3.0 cm, and 24% with tumors of 3.1–7.0 cm. At 36 mo, overall survival was 90%, with metastasis and death from kidney cancer in only one patient who refused intervention. The cumulative incidence rates of treatment were 6%, 11%, and 13% at 1, 2, and 3 yr, respectively, with 9.6% for ≤2 cm, 16% for 2.1–3.0 cm, and 18% for >3 cm tumors at 3 yr. Limitations include the study’s retrospective review of prospectively enrolled data limiting conclusions beyond 3 yr of follow-up.

Conclusions and clinical implications

MUSIC practices initiate AS for >50% of patients with 13% incidence of delayed intervention and <1% incidence of metastasis within 3 yr, indicating that AS is a safe and durable option for many patients with cT1RMs. Further investigations into imaging protocols and longer-term outcomes of AS are warranted.

Patient summary

In Michigan, most patients diagnosed with localized renal masses of <4 cm and some with tumors up to 7 cm in size elect active surveillance (AS), with a 13% cumulative incidence of undergoing intervention within 3 yr of detection. At 3 yr after initiating AS, the cohort had 90% overall survival and >99% cancer-specific survival, indicating that AS is a safe and durable strategy.

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