Surveillance of Complex Renal Cysts - the SOCRATIC Study
- Conditions
- Complex Renal Cyst
- Interventions
- Procedure: Active surveillanceProcedure: Surgery
- Registration Number
- NCT04558593
- Lead Sponsor
- Université de Sherbrooke
- Brief Summary
One third of individuals aged \>60 years will be diagnosed with at least one renal cyst following abdominal imaging. These cystic lesions are categorized according to the Bosniak classification which categorizes cysts according to their degree of complexity and risk of malignancy. Growing evidence suggests that a significant proportion of Bosniak III and IV cysts are benign and that the malignant ones present low metastatic potential. Since renal surgery carries substantial morbidity (20%) and potential mortality (0.5%), active surveillance has gained attention as a potential tradeoff to surgery to overcome overtreatment. Therefore, prospective studies of long-term follow-up are needed to confirm the oncologic safety of this strategy for patients with Bosniak III/IV cysts.
This is an multicenter prospective observational longitudinal study. The main objective is to compare the 5-year follow-up cancer-specific survival between the active surveillance and the surgical groups.
- Detailed Description
Background: One in three patients over 60 years old will be diagnosed with a renal cyst following abdominal imaging. Traditionally, experts have recommended that complex cystic lesions (also known as Bosniak III - IV cysts) should be surgically removed, but recent evidences suggest that many are benign or have low metastatic potential. Thus, active surveillance which involves close follow-up of a patient's condition, was proposed as a tradeoff option to surgery.
Design: Multicenter observational longitudinal prospective cohort study
Objectives: The goal of this multicenter project is to conduct a prospective study with a 5-year follow-up to confirm the oncologic outcomes of active surveillance in the management of complex cysts. The main objectives are: 1) to compare the 5-year cancer specific survival between cysts managed by surgery and active surveillance; 2) to evaluate disease progression; 3) to evaluate patient's well-being according to each management strategy; and 4) to compare the 5-year healthcare cost of both management approaches.
Study population: Patients incidentally diagnosed with a Bosniak III and/or IV cysts, who are deemed to have at least 5 years of life, and who opted to be managed by either surgery or active surveillance. (N=330)
Follow-up: Patients will DECIDE if they want to have a surgery or to be followed by active surveillance. All patients will be followed as per standard of care with either semi-annual and annual visits. Research visits will serve to assess vital status and quality of life scores (through validated questionnaires). Patients on active surveillance will also be assessed for cyst progression and might be offered invasive or systemic therapy if progression is observed.
Recruitment & Eligibility
- Status
- RECRUITING
- Sex
- All
- Target Recruitment
- 330
- 18 years old and older;
- diagnosed with a Bosniak III or IV cyst (classification 2019);
- size of cystic component ≤7cm;
- cyst wall/septum nodule (obtuse margin of protrusion) <10mm (perpendicular axis) or nodular/solid component ≤2 cm in any axis;
- life expectancy >5 years (by physician's estimate);
- new diagnosis ≤ 12 months from accrual date;
- currently asymptomatic from the disease;
- deemed fit enough for surgery;
- willingness and ability to complete questionnaires in either French or English;
- able and willing to provide informed consent
- history of a hereditary renal cancer syndrome;
- presence of polycystic kidney disease;
- any prior history of RCC;
- received systemic therapy for another malignancy within the 12 months prior to accrual;
- uncontrolled medical illness including infections, hypertension, arrhythmias, heart failure, or myocardial infarction/unstable angina within 6 months that would predispose to immediate surgical therapy;
- metastatic disease or evidence of vascular or nodal disease;
- unwillingness to undergo monitoring and imaging studies;
- any contra-indication(s) to contrast-enhanced imaging (estimated glomerular filtration rate <30min/mL)
Study & Design
- Study Type
- OBSERVATIONAL
- Study Design
- Not specified
- Arm && Interventions
Group Intervention Description active surveillance Active surveillance 220 participants will be included in the active surveillance group. Active surveillance is close monitoring (every 6 months the first 3 years following diagnosis and annually the following years), done per standard of care Close monitoring include: abdominal imaging (ultrasound, CT or MRI), chest X-ray or CT scan and blood tests surgery Surgery 110 participants will be included in the surgery group. Surgery is done per standard of care. The type of surgery is at the discretion of the treating physician and may include: partial resection, total resection, thermoablation.
- Primary Outcome Measures
Name Time Method 5-year cancer-specific survival from the date of enrollment (defined by signed consent) to the end of follow-up (up to 5 years) Defined as kidney cancer survival 5 years after the enrollment
- Secondary Outcome Measures
Name Time Method 5-year overall survival from the date of enrollment (defined by signed consent) to the end of follow-up (up to 5 years) Defined as survival 5 years after enrollment
2-year overall survival from the date of enrollment (defined by signed consent) up to 2 years of follow-up Defined as survival 2 years after enrollment
2-year cancer-specific survival from the date of enrollment (defined by signed consent) up to 2 years of follow-up Defined as kidney cancer survival 2 years after the enrollment
Discontinuation rate from the date of enrollment (defined by signed consent) to the end of follow-up (up to 5 years) Defined as the number of people who discontinued active surveillance at the end of the study (over the total)
Tumor growth rate if there is a progression, at the time of imaging (undefined, between 6 months and 5 years post-enrollment) Defined by change in volume (cm3 ) and change in maximal diameter measured over time (years). Volume will be calculated using the formula for ellipsoid volume: 0.5326 x length x width x height.
Tumor progression rate if there is a progression, at the time of imaging (undefined, between 3 months and 5 years post-enrollment) Defined as the percentage of patients with tumors that have met our pre-specified progression endpoints
Time to tumor progression (Progression-free survival) range of time from enrollment to progression (undefined, between 3 months and 5 years post-enrollment) or end of follow-up (5 years post-enrollment) Defined as the time from the date of enrollment to the date where an individual experienced tumor progression or censoring due to lost to follow-up or the end of follow-up period
Patient and tumor characteristics in correlation with cancer-specific death at the baseline visit (no more than 30 days after signed consent) Defined as demographic (i.e. age, sex, comorbidities, medical history, etc) and tumor characteristics (i.e. tumor size, tumor complexity, etc) associated with kidney cancer deaths
Perceived health change over time range of time from enrollment to end of follow-up (maximum 5 years post-enrollment) Defined as the change in EQ5D-5L scores over time (enrollment to censoring due to lost of follow-up or the end of follow-up period).
Treatment-free survival from the date of enrollment (defined by signed consent) up to 2 and 5 years of follow-up Defined as survival without treatment (in active surveillance group)
Quality of life change over time range of time from enrollment to end of follow-up (maximum 5 years post-enrollment) Defined as the change in short form health survey (SF-12) scores over time (enrollment to censoring due to lost of follow-up or the end of follow-up period).
Patient and tumor characteristics in correlation with disease progression at the baseline visit (no more than 30 days after signed consent) Defined as demographic (i.e. age, sex, comorbidities, medical history, etc) and tumor characteristics (i.e. tumor size, tumor complexity, etc) associated with disease progression.
Anxiety change over time range of time from enrollment to end of follow-up (maximum 5 years post-enrollment) Defined as the change in Hospital Anxiety and Depression Scale (HADS) scores over time (enrollment to censoring due to lost of follow-up or the end of follow-up period).
Health cost range of time from enrollment to end of follow-up (maximum 5 years post-enrollment) Defined as the total direct (patients) and indirect (healthcare system) cost associated with the management of a complex cyst according to each treatment strategy (active surveillance and surgery).
Trial Locations
- Locations (17)
Mens Health Clinic
🇨🇦Winnipeg, Manitoba, Canada
Prostate Cancer Center
🇨🇦Calgary, Alberta, Canada
Northern Alberta Urology Center
🇨🇦Edmonton, Alberta, Canada
Vancouver Prostate Centre
🇨🇦Vancouver, British Columbia, Canada
Nova Scotia Health Authority
🇨🇦Halifax, Nova Scotia, Canada
St-Joseph's Hospital
🇨🇦Hamilton, Ontario, Canada
The Ottawa Hospital
🇨🇦Ottawa, Ontario, Canada
Thunder Bay Health Sciences Center
🇨🇦Thunder Bay, Ontario, Canada
Princess Margaret Hospital
🇨🇦Toronto, Ontario, Canada
Woodstock hospital
🇨🇦Woodstock, Ontario, Canada
Centre intégré de santé et de services sociaux de Chaudière-Appalaches - Hôtel-Dieu de Lévis
🇨🇦Lévis, Quebec, Canada
CHUM
🇨🇦Montreal, Quebec, Canada
Hôpital Maisonneuve-Rosemont (CISSS-EIMtl)
🇨🇦Montreal, Quebec, Canada
McGill University Health Centre
🇨🇦Montreal, Quebec, Canada
CHU de Québec - Université Laval
🇨🇦Québec, Quebec, Canada
Centre de recherche du Centre hospitalier Universitaire de Sherbrooke
🇨🇦Sherbrooke, Quebec, Canada
CHU Bordeaux (URO-CCR)
🇫🇷Bordeaux, France