Active surveillance with delayed intervention a safe, cheaper option for small renal masses

Active surveillance (AS) along with timely delayed intervention (DI) is a safe and economical alternative to immediate intervention in patients with small renal masses (SRM), suggests a study.

A group of researchers estimated the health outcomes and costs of four management strategies for 65-year-old patients with an incidental SRM (ie, AS with possible DI, immediate partial nephrectomy, radical nephrectomy, and thermal ablation) using a decision analytic Markov modeling.

They also evaluated mortality, direct medical costs, quality-adjusted life-years, and incremental cost-effectiveness rations over 10 years.

The rates of all-cause mortality at 10 years were 22.6 percent for AS, 21.9 percent for immediate partial nephrectomy, 22.4 percent for immediate radical nephrectomy, and 23.7 percent for immediate thermal ablation. AS was the most cost-effective approach at a willingness-to-pay threshold of $100,000 per quality-adjusted life-year.

“The results were robust in univariate, multivariate, and probabilistic sensitivity analyses,” the researchers said.

In clinical decision analysis, the tumour’s metastatic potential, patient age, individual preferences, and health status were significantly associated with optimal management strategy.

Of note, AS would be the better option than other management strategies if the annual probability of metastatic progression from AS was sufficiently low (under 0.35 percent to 0.45 percent for most ages at baseline), consistent with the typical metastatic potential of SRMs <2 cm.

“For patients harbouring tumours of very low metastatic potential, AS may lead to better patient outcomes than immediate intervention,” the researchers said.