Abou Youssif Tamer, Kassouf Wassim, Steinberg Jordan, Aprikian Armen G, Laplante Micheal P, Tanguay Simon
Division of Urology, Department of Surgery, McGill University Health Center, Montreal, Quebec, Canada.
Cancer. 2007 Sep 1;110(5):1010-4. doi: 10.1002/cncr.22871.
The objective of the current study was to evaluate the outcome of a surveillance strategy in patients with renal masses.
The medical records of patients with renal masses diagnosed between January 1992 and May 2006 were reviewed retrospectively. In all, 45 patients with renal masses under observation were identified. Of these, 35 patients with 44 renal masses measuring <4 cm in dimension at the time of diagnosis and who were followed for at least 6 months were included in the review. Patients elected observation because of age, comorbidity, solitary kidney, or bilateral renal masses. Medical records were reviewed to determine tumor size and volume changes as well as clinical progression requiring treatment, the development of metastatic disease, or death.
A total of 35 patients (21 men and 14 women) with 44 renal masses were observed for a mean follow-up of 47.6 months. The mean age of these patients was 71.8 years. The majority of the patients (89%) were asymptomatic at the time of diagnosis. The mean and median initial tumor dimension was 2.2 cm and 2.2 cm, respectively (range, 0.5-4 cm). Of the 35 patients, 2 (5.7%) were lost to follow-up, 8 (22.9%) underwent surgical resection, and 9 (25.7%) died of other causes. The mean dimension growth rate was 0.21 cm/year (range, 0.03-1.9 cm/year). The mean and median volume growth rate was 2.7 cc/year and 1.4 cc/year, respectively. Progression to metastatic disease was identified in 2 patients (5.7%).
The majority of renal masses will grow if observed and some may require treatment. Initial tumor size cannot predict the natural history of renal masses. A small but non-negligible risk of developing metastatic disease exists in this patient population. Further research should focus on the role of biopsy and on identification of prognostic parameters allowing more accurate prediction of tumor growth and metastasis.
本研究的目的是评估肾肿块患者监测策略的结果。
回顾性分析1992年1月至2006年5月间诊断为肾肿块患者的病历。共确定了45例接受观察的肾肿块患者。其中，35例患者的44个肾肿块在诊断时直径<4 cm且随访至少6个月，纳入本综述。患者因年龄、合并症、单肾或双侧肾肿块而选择观察。查阅病历以确定肿瘤大小和体积变化以及需要治疗的临床进展、转移性疾病的发生或死亡情况。
共观察了35例患者（21例男性和14例女性）的44个肾肿块，平均随访47.6个月。这些患者的平均年龄为71.8岁。大多数患者（89%）在诊断时无症状。初始肿瘤的平均和中位直径分别为2.2 cm和2.2 cm（范围为0.5 - 4 cm）。35例患者中，2例（5.7%）失访，8例（22.9%）接受了手术切除，9例（25.7%）死于其他原因。平均直径增长率为0.21 cm/年（范围为0.03 - 1.9 cm/年）。平均和中位体积增长率分别为2.7 cc/年和1.4 cc/年。2例患者（5.7%）出现了转移性疾病进展。
大多数肾肿块如果进行观察会生长，有些可能需要治疗。初始肿瘤大小不能预测肾肿块的自然病程。该患者群体存在发生转移性疾病的小但不可忽视的风险。进一步的研究应聚焦于活检的作用以及识别能够更准确预测肿瘤生长和转移的预后参数。
