Lamb Gavin W A, Bromwich Emma J, Vasey Paul, Aitchison Michael
Department of Urology, Gartnavel General Hospital, Glasgow, United Kingdom.
Urology. 2004 Nov;64(5):909-13. doi: 10.1016/j.urology.2004.05.039.
To examine a group of elderly patients with much larger tumors who were deemed unlikely to survive surgery or who would require dialysis postoperatively to establish the natural history of larger renal tumors if left untreated. Little is known of the growth rate and natural history of renal cancer progression because the tumor is usually removed in those patients who can tolerate surgery. The only published data have been in relation to unfit patients with small, homogeneous, well-circumscribed tumors less than 4 cm.
We identified 36 patients whose tumor had not been removed, without evidence of metastasis at diagnosis, from a database of 421 patients with renal cancer. The data were examined retrospectively for symptoms, survival, and size change.
The mean age of the patients treated conservatively was 76.1 years (range 56 to 91), with median tumor size of 6.0 cm (range 3.5 to 20.0) at diagnosis. The median follow-up period was 24 months (range 3 to 136). Of the 36 patients, 13 had died at follow-up, 8 of an unrelated illness and 5 of an unknown cause with no radiologic evidence of progression but severe comorbidity. The median time to death was 9 months (range 3 to 24) after diagnosis. One patient developed metastasis at 132 months and was still alive at 136 months of follow-up. Significant hematuria occurred in 11% of the patients and was successfully managed either conservatively or by embolization. The tumor size was unchanged in most patients during the follow-up period.
In elderly patients, or those with severe comorbidity, conservative management of larger renal masses is a reasonable and safe option.
研究一组肿瘤体积大得多的老年患者，这些患者被认为手术难以存活或术后需要透析，以确定未治疗的较大肾肿瘤的自然病程。由于通常在能够耐受手术的患者中切除肿瘤，因此对肾癌进展的生长速率和自然病程了解甚少。唯一已发表的数据涉及不适合手术的、肿瘤小、均匀、边界清晰且小于4厘米的患者。
我们从421例肾癌患者数据库中识别出36例肿瘤未切除、诊断时无转移证据的患者。对这些数据进行回顾性分析，以了解症状、生存率和肿瘤大小变化。
保守治疗患者的平均年龄为76.1岁（范围56至91岁），诊断时肿瘤大小中位数为6.0厘米（范围3.5至20.0厘米）。中位随访期为24个月（范围3至136个月）。在这36例患者中，13例在随访时死亡，8例死于无关疾病，5例死因不明，无影像学进展证据但有严重合并症。诊断后至死亡的中位时间为9个月（范围3至24个月）。1例患者在132个月时发生转移，随访至136个月时仍存活。11%的患者出现明显血尿，通过保守治疗或栓塞成功处理。大多数患者在随访期间肿瘤大小无变化。
对于老年患者或合并严重疾病的患者，对较大肾肿块进行保守治疗是一种合理且安全的选择。
