Alam Ridwan, Yerrapragada Anirudh, Wlajnitz Tina, Watts Emelia, Pallauf Maximilian, Enikeev Dmitry, Chang Peter, Wagner Andrew A, McKiernan James M, Pierorazio Phillip M, Allaf Mohamad E, Singla Nirmish
Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, FL, USA.
Eur Urol Open Sci. 2023 Mar 1;50:78-84. doi: 10.1016/j.euros.2023.02.004. eCollection 2023 Apr.
As the adoption of active surveillance (AS) for small renal masses (SRMs) grows, the number of elderly patients enrolled for a prolonged period of time will increase. However, our understanding of comparative growth rates (GRs) in aging patients with SRMs remains poor.
To examine whether particular age cutoffs are associated with an increased GR for patients undergoing AS for SRMs.
We identified all patients with SRMs enrolled in the multi-institutional, prospective Delayed Intervention and Surveillance for Small Renal Masses (DISSRM) registry since 2009 who elected for AS.
Two definitions of GR were examined: GR from the initial image (GR) and GR from the prior image (GR). Image measurements were dichotomized based on patient age at the time of imaging. Multiple age cutoffs were examined: 65, 70, 75, and 80 yr. Mixed-effect linear regression examined the associations between age and GR, with controlling to account for multiple measurements from the same individual.
We examined 2542 measurements from 571 patients. The median age at enrollment was 70.9 yr (interquartile range [IQR] 63.2-77.4) with a median tumor diameter of 1.8 cm (IQR 1.4-2.5). As a continuous variable, age was not associated with GR (-0.0001 cm/yr, 95% confidence interval [CI] -0.007 to 0.007, = 0.97) or GR (0.008 cm/yr, 95% CI -0.004 to 0.020, = 0.17) after adjustment. The only age thresholds associated with an increased GR were 65 yr for GR and 70 yr for GR. Limitations include the one-dimensional nature of the measurements used.
Increased age for patients on AS for SRMs is not associated with increased GRs.
We examined whether patients undergoing active surveillance (AS) exhibited accelerated growth of their small renal masses (SRMs) after a certain age. No demonstrable change was seen, suggesting that AS is a safe and durable management option for aging patients with SRMs.
随着对小肾肿块（SRM）采用主动监测（AS）的情况增多，长期参与监测的老年患者数量将会增加。然而，我们对老年SRM患者的相对生长率（GR）的了解仍然不足。
探讨对于接受SRM主动监测的患者，特定的年龄界限是否与生长率增加相关。
设计、设置与参与者：我们确定了自2009年以来在多机构前瞻性小肾肿块延迟干预与监测（DISSRM）注册研究中入选并选择接受AS的所有SRM患者。
研究了生长率的两种定义：初始图像的生长率（GR）和前次图像的生长率（GR）。图像测量结果根据成像时患者的年龄进行二分法划分。研究了多个年龄界限：65岁、70岁、75岁和80岁。采用混合效应线性回归分析年龄与生长率之间的关联，并对来自同一患者的多次测量结果进行控制。
我们分析了571例患者的2542次测量结果。入组时的中位年龄为70.9岁（四分位间距[IQR]63.2 - 77.4），肿瘤中位直径为1.8 cm（IQR 1.4 - 2.5）。作为连续变量，调整后年龄与GR（-0.0001 cm/年，95%置信区间[CI] -0.007至0.007，P = 0.97）或GR（0.008 cm/年，95% CI -0.004至0.020，P = 0.17）均无关联。与生长率增加相关的唯一年龄界限是GR为65岁，GR为70岁。局限性包括所使用测量方法的一维性质。
接受SRM主动监测的患者年龄增加与生长率增加无关。
我们研究了接受主动监测（AS）的患者在达到一定年龄后其小肾肿块（SRM）是否出现加速生长。未观察到明显变化，这表明AS对于老年SRM患者是一种安全且持久的管理选择。
