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MP14-10 USE OF DELAYED INTERVENTION FOR SMALL RENAL MASSES INITIALLY MANAGED WITH ACTIVE SURVEILLANCE

INTRODUCTION AND OBJECTIVES: A number of patients who elect active surveillance of their small renal masses (⩽4 cm) subsequently pursue delayed intervention. The indications, timing, and rates of delayed intervention have not been well determined prospectively. METHODS: Data from DISSRM (Delayed Intervention and Surveillance for Small Renal Masses), a prospective, multi-institutional registry was utilized to evaluate factors associated with delayed intervention between 2009-2018. RESULTS: Of 371 patients enrolled in active surveillance, 46(12.4%) pursued delayed intervention. Patients who pursued delayed intervention spent a median 12 months on surveillance (IQR5.5-23.6), had better functional status (p<0.01), and had greater median growth rate versus those who remained on surveillance (0.38 vs 0.05, p<0.001). Indications for intervention included growth rate >0.5cm/year for 23 (50%) patients, patient preference for 22 (47.8%) patients, and qualification for renal transplant in 1 (2.2%) patient. Thirty-two patients (69.6%) underwent nephron-sparing surgery, 5 (10.9%) underwent radical nephrectomy, and 9 (19.6%) underwent percutaneous cryoablation. Renal mass biopsy was utilized in 37 (11.4%) and 15 (32.7%) patients in the AS and delayed intervention arms, respectively, (p=0.04). No patients experienced metastatic progression or died of kidney cancer. CONCLUSIONS: As nearly 50% of patients pursue delayed intervention secondary to anxiety in the absence of clinical progression, comprehensive counseling is essential to determine if patients are suitable for a surveillance protocol. Active surveillance remains a safe initial management option for many patients but may not be a durable strategy for patients who are acceptable surgical candidates with an extended life expectancy. Delayed intervention does not compromise oncologic outcomes or limit treatment options. Figure. No caption available. Source of Funding: None