Pallauf Maximilian, Rezaee Michael, Elias Roy, Wlajnitz Tina, Fletcher Sean A, Cheaib Joseph, Alkhatib Khalid, Chang Peter, Wagner Andrew A, McKiernan James M, Allaf Mohamad E, Pierorazio Phillip M, Singla Nirmish
Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Department of Urology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria.
BJU Int. 2025 May;135(5):860-868. doi: 10.1111/bju.16651. Epub 2025 Jan 28.
To evaluate the association between tumour size and the growth rate (GR) of small renal masses (SRMs) in patients managed by active surveillance (AS).
We queried the prospective, multi-institutional Delayed Intervention and Surveillance for Small Renal Masses (DISSRM) registry for patients on AS with an imaging interval of ≥6 months, identifying 456 patients. We tracked tumour size over time; a GR >0.5 cm/year was defined as a GR event. We used multivariable recurrent events and time-to-event Cox regression modelling to evaluate the association between tumour size and GR events (primary outcome) and tumour size and delayed intervention (DI; secondary outcome). We tested tumour size as a continuous variable and dichotomised tumour size by predefined (2-cm) and calculated (2.9-cm) cutoffs. We calculated the cutoff using maximally selected rank statistics and time to progression, defined according to the DISSRM registry.
The median (interquartile range) follow-up of patients on AS was 40.1 (26.4-71.2) months, during which 128 patients (28%) had ≥1 GR event, and 80 (18%) underwent DI. Larger tumour size was an independent predictor for GR events and DI when tested as a continuous and a dichotomous variable in multivariable analyses (all P < 0.05). The association was strongest when accounting for the change in tumour size over time and when applying the 2.9-cm cutoff. The study is limited by the mixed tumour pathology inert to SRMs.
Larger tumour size was independently associated with GR events and DI for patients with SRMs on AS. A 2.9-cm cutoff may provide valuable information for patient counselling.
评估主动监测（AS）管理的小肾肿块（SRM）患者的肿瘤大小与生长速率（GR）之间的关联。
我们查询了前瞻性、多机构的小肾肿块延迟干预与监测（DISSRM）登记处中接受AS且影像检查间隔≥6个月的患者，共识别出456例患者。我们随时间跟踪肿瘤大小；GR>0.5 cm/年被定义为GR事件。我们使用多变量复发事件和事件发生时间Cox回归模型来评估肿瘤大小与GR事件（主要结局）以及肿瘤大小与延迟干预（DI；次要结局）之间的关联。我们将肿瘤大小作为连续变量进行测试，并通过预定义（2 cm）和计算得出（2.9 cm）的临界值将肿瘤大小进行二分。我们使用最大选择秩统计量和根据DISSRM登记处定义的进展时间来计算临界值。
接受AS的患者的中位（四分位间距）随访时间为40.1（26.4 - 71.2）个月，在此期间，128例患者（28%）发生≥1次GR事件，80例（18%）接受了DI。在多变量分析中，当将肿瘤大小作为连续变量和二分变量进行测试时，较大的肿瘤大小是GR事件和DI的独立预测因素（所有P<0.05）。当考虑肿瘤大小随时间的变化以及应用2.9 cm临界值时，这种关联最为强烈。该研究受到SRM惰性混合肿瘤病理的限制。
对于接受AS的SRM患者，较大的肿瘤大小与GR事件和DI独立相关。2.9 cm的临界值可能为患者咨询提供有价值的信息。
