Abstract
Background
Active surveillance (AS) is a commonly used strategy in patients with slow-growing
disease. We aimed to assess the outcomes and safety of AS in patients with metastatic
renal cell carcinoma (mRCC).
Patients and Methods
We used the Canadian Kidney Cancer information system (CKCis) to identify patients
with mRCC diagnosed between January 1, 2011, and December 31, 2016. The AS strategy
was defined as (1) the start of systemic therapy ≥ 6 months after diagnosis of mRCC,
or (2) never receiving systemic therapy for mRCC with an overall survival (OS) of
≥1 year. Patients starting systemic treatment <6 months after diagnosis of mRCC were
defined as receiving immediate systemic treatment. OS and time until first-line treatment
failure (TTF) were compared between the two cohorts.
Results
A total of 853 patients met the criteria for AS (cohort A). Of these, 364 started
treatment >6 months after their initial diagnosis (cohort A1) and 489 never started
systemic therapy (cohort A2); 827 patients received immediate systemic treatment (cohort
B). The 5-year OS probability was significantly greater for cohort A than for cohort
B (70% vs. 33.6%; P < .0001). After adjusting for International Metastatic RCC Database Consortium risk
criteria and age, both OS (hazard ratio [HR] = 0.58; 95% confidence interval [CI],
0.47-0.70; P < .0001) and TTF (HR = 0.72; 95% CI, 0.60-0.85; P = .0002) were greater in cohort A1 compared with B. For cohort A1, the median time
on AS was 14.2 months (range, 6-71).
Conclusions
Based on the largest analysis of AS in mRCC to date, our data suggest that a subset
of patients may be safely observed without immediate initiation of systemic therapy.
Keywords
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Article info
Publication history
Published online: May 15, 2021
Accepted:
May 3,
2021
Received in revised form:
April 23,
2021
Received:
January 22,
2021
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
