Beisland Christian, Hjelle Karin M, Reisaeter Lars A R, Bostad Leif
Department of Surgical Sciences, University of Bergen, Bergen, Norway.
Eur Urol. 2009 Jun;55(6):1419-27. doi: 10.1016/j.eururo.2008.12.031. Epub 2009 Jan 7.
Renal masses diagnosed in older and comorbid patients represent a challenge with regard to treatment.
To evaluate clinical outcome and tumor progression in patients with renal masses managed by observation due to age and comorbidity.
DESIGN, SETTING, AND PARTICIPANTS: The medical records of 63 consecutive patients with renal masses primarily managed by observation during 2002-2007 were reviewed retrospectively and analyzed. The mean age for all patients at diagnosis was 76.6 yr, and 59% were male. Mean tumor size was 4.3 cm in diameter at diagnosis. Of these, 30% had Eastern Cooperative Oncology Group performance status (PS) of 2 or 3, 78% were American Society of Anesthesiologists (ASA) class 3, and the patients had a mean of 2.8 other medical conditions.
Registration of age, ASA class, PS, comorbid conditions, computed tomography scans, primary tumor size, tumor growth rate, pathology parameters, observation time, survival time.
Five-year overall survival (OS) and cancer-specific survival (CSS) rates were 42.8% and 93.3%, respectively. For tumors < or =4.0 cm in size, 5-yr CSS was 100%. Nine patients received delayed radical treatment, none of whom had later progression of the disease. In 18 patients histopathologic diagnosis of the renal masses were available, and in 15 patients (83%) renal cell carcinoma (RCC) was verified. The annual growth rate was <1cm/yr in 85.4% of the cases. In tumors < or =4.0 cm, only 1 of 27 tumors (3.7%) grew faster than 1cm/yr.
Management of renal masses by observation among older and comorbid patients seems to give acceptable results with regard to OS and CSS rates after 5 yr. The risk of disease progression is significantly higher in patients with larger sized renal masses (>4 cm). Thus, selection for observation in this group has to be stricter than in a group of patients with smaller sized renal masses (< or =4.0 cm).
在老年和合并其他疾病的患者中诊断出的肾肿块在治疗方面是一项挑战。
评估因年龄和合并症而接受观察治疗的肾肿块患者的临床结局和肿瘤进展情况。
设计、背景和参与者：回顾性分析了2002年至2007年期间63例主要接受观察治疗的肾肿块患者的病历。所有患者诊断时的平均年龄为76.6岁，59%为男性。诊断时肿瘤平均直径为4.3厘米。其中，30%的东部肿瘤协作组体能状态（PS）为2或3，78%为美国麻醉医师协会（ASA）3级，患者平均合并2.8种其他疾病。
记录年龄、ASA分级、PS、合并症、计算机断层扫描、原发肿瘤大小、肿瘤生长率、病理参数、观察时间、生存时间。
5年总生存率（OS）和癌症特异性生存率（CSS）分别为42.8%和93.3%。对于直径≤4.0厘米的肿瘤，5年CSS为100%。9例患者接受了延迟根治性治疗，均无疾病进展。18例患者有肾肿块的组织病理学诊断结果，15例（83%）确诊为肾细胞癌（RCC）。85.4%的病例年生长率<1厘米/年。在直径≤4.0厘米的肿瘤中，27个肿瘤中只有1个（3.7%）生长速度超过1厘米/年。
在老年和合并症患者中通过观察来处理肾肿块，在5年后的OS和CSS率方面似乎能取得可接受的结果。肾肿块较大（>4厘米）的患者疾病进展风险显著更高。因此，该组患者选择观察治疗必须比肾肿块较小（≤4.0厘米）的患者组更严格。
