Volume 74, Issue 2, Pages 157-164 (August 2018) Active Surveillance for Localized Renal Masses: Tumor Growth, Delayed Intervention Rates, and >5-yr Clinical Outcomes  Andrew G. McIntosh, Benjamin T. Ristau, Karen Ruth, Rachel Jennings, Eric Ross, Marc C. Smaldone, David Y.T. Chen, Rosalia Viterbo, Richard E. Greenberg, Alexander Kutikov, Robert G. Uzzo  European Urology  Volume 74, Issue 2, Pages 157-164 (August 2018) DOI: 10.1016/j.eururo.2018.03.011 Copyright © 2018 European Association of Urology Terms and Conditions

Fig. 1 Flow diagram for patient selection and exclusions from Fox Chase Cancer Center kidney tumor database. AS=active surveillance. European Urology 2018 74, 157-164DOI: (10.1016/j.eururo.2018.03.011) Copyright © 2018 European Association of Urology Terms and Conditions

Fig. 2 Waterfall plot demonstrating the distribution of linear growth rates (LGRs), by delayed intervention (DI) status. In the event a patient had multiple lesions, the largest lesion (for no DI patients) or the first lesion to have surgery (DI patients) was utilized. European Urology 2018 74, 157-164DOI: (10.1016/j.eururo.2018.03.011) Copyright © 2018 European Association of Urology Terms and Conditions

Fig. 3 (A) Cumulative incidence (CI) of delayed intervention (DI) over time—no difference between solid and cystic masses at 2 yr (32% [95% CI 27–37%] vs 30% [95% CI 20–44%]) and 3 yr (40% [95% CI 34–46%] vs 32% [95% CI 22–46%]; p=0.5). (B) Increasing iLGR was associated with higher cumulative DI rates (p=0.018). CI estimates of DI for the no growth, low iLGR, moderate iLGR, and high iLGR groups were 15%, 20%, 26%, and 34%, and 34%, 36%, 51%, and 45%, at 1 and 3 yr, respectively. iLGR=initial linear growth rate; LGR=linear growth rate. European Urology 2018 74, 157-164DOI: (10.1016/j.eururo.2018.03.011) Copyright © 2018 European Association of Urology Terms and Conditions

Fig. 4 (A) Kaplan-Meier (KM) estimates for overall survival (OS) from first surveillance imaging date between initial LGR (iLGR) groups. No difference is demonstrated between 5-yr OS rates in the no growth (85%, 95% CI 78–90%), low iLGR (89%, 95% CI 79–94%), moderate iLGR (83%, 95% CI 67–92%), and high iLGR (83%, 95% CI 71–90%) groups (p=0.4). (B) Age- and tumor composition–adjusted Cox regression for OS also demonstrates no difference in OS by iLGR group (p=0.8). (C) KM estimates for OS by tumor composition demonstrates improved 5-yr OS for cystic (95%, 95% CI 84–98%) versus solid (88%, 95% CI 84–91%) masses (p=0.01). CI=cumulative incidence; HR=hazard ratio; LGR=linear growth rate. European Urology 2018 74, 157-164DOI: (10.1016/j.eururo.2018.03.011) Copyright © 2018 European Association of Urology Terms and Conditions