Study evaluates use of active surveillance in patients with renal masses

In this video, Yuzhi (Katherine) Wang, MD, shares the background and key findings from the study, “Appropriateness of active surveillance based on life expectancy predictions in MUSIC-Kidney,” which was presented at the 2024 American Urological Association Annual Meeting in San Antonio, Texas. Wang is currently a research fellow at Henry Ford Health in Detroit, Michigan.

Video Transcript:

So, MUSIC collects data on surgery and surgical outcomes like I just talked about, but we also have a lot of patients on active surveillance. In fact, almost half of the patients diagnosed with kidney cancer in MUSIC go on active surveillance. That's really high compared to what's published in the literature, which is around 10%. If you're looking at 48% compared to 10%, that's a lot. We wanted to see if we were appropriately surveilling patients, since we're doing so much surveillance compared to the rest of the urology community. We actually have a page called AskMUSIC.com, where we have a life expectancy calculator. It takes several variables into account, like age and comorbidity to calculate a predicted life expectancy. A couple of years ago, we had a Delphi Consensus Panel that looked at life expectancy vs tumor size, and made several categories to deem patients that are appropriate vs inappropriate for active surveillance. So, patients with smaller tumors, for example, would be more appropriate for active surveillance, or patients with a limited life expectancy, with other comorbidities would be appropriate for active surveillance, vs patients that have a big mass and a really long life expectancy; you might want to think about treating that.

Based on that model, we wanted to fit our patients to see if we are appropriately surveilling them. We took around 4000 patients in the registry at the time of data analysis and fit them into this model. Around 80% of our patients who went on active surveillance were appropriate for active surveillance, which is good. We're doing a lot of active surveillance, and it's good to know that most of these people are getting the appropriate care that they should receive. It was also interesting to look at patients that ended up getting treatment. There was a good proportion, around 30%, that actually could have gotten active surveillance. They were categorized as appropriate for active surveillance. However, I think the main takeaway is that active surveillance isn't just based on a calculator, or a graph, a model. It's a big decision between the patient and the physician. There are a lot of other nuances that go into it. For example, patient preference. A lot of patients get anxious being on active surveillance, knowing that they have cancer in their body, even if it's slow growing or indolent. It can be scary for sure, and totally understandable for a patient to want to undergo surgery. So, it's good to know that we are mostly appropriately giving patients active surveillance, but it's not the end all be all. There's a lot of other things that go into it.

This transcription has been edited for clarity.