Department of Urology, Columbia University, New York, New York, USA.
Curr Opin Urol. 2010 Mar;20(2):105-10. doi: 10.1097/MOU.0b013e32833625f8.
Although surgical resection is the current standard for treatment of small (<4 cm) renal cortical neoplasms, active surveillance remains an option in selected patients depending on tumor characteristics and surgical risk. We review the natural history of small renal masses according to the current literature, and highlight issues regarding the recent guidelines for the management of T1 renal masses put forth by the American Urological Association.
The natural history of small renal masses is still largely unknown; however, initial size or volume of the mass seems to predict the risk of malignancy in retrospective studies. A new study found that growth rate is inversely related to initial tumor volume, with smaller masses growing faster in the beginning and decreasing in rate of growth as they enlarge. Biomarkers such as carbonic anhydrase IX, vascular endothelial growth factor, and CD147 have demonstrated some value in predicting tumor characteristics and prognosis in renal cell carcinoma. Finally, we suggest modifications to the new American Urological Association guidelines based on the authors' experience in order to optimize the management of renal cortical neoplasms.
The natural history of small renal masses is not completely understood. Growth rate and tumor size are factors shown to be predictive of tumor biology. Currently, there are no specific tumor markers to determine initial risk or progression to metastatic disease; however, investigation into new molecules is being undertaken. The guidelines presented by the American Urological Association give a formal framework for the management of T1 renal cortical neoplasms; however, we site specific modifications and recommend that they be considered when evaluating patients for treatment.
虽然手术切除是目前治疗小(<4cm)肾皮质肿瘤的标准方法，但根据肿瘤特征和手术风险，在一些特定患者中，主动监测仍然是一种选择。我们根据目前的文献回顾了小肾肿块的自然史，并强调了美国泌尿外科学会提出的关于 T1 肾肿块管理的最新指南中的一些问题。
小肾肿块的自然史在很大程度上仍然未知；然而，在回顾性研究中，肿块的初始大小或体积似乎预测了恶性肿瘤的风险。一项新的研究发现，生长速度与初始肿瘤体积呈反比，较小的肿块在开始时生长得更快，随着肿块增大，生长速度逐渐降低。碳酸酐酶 IX、血管内皮生长因子和 CD147 等生物标志物在预测肾细胞癌的肿瘤特征和预后方面显示出了一定的价值。最后，我们根据作者的经验对美国泌尿外科学会的新指南提出了修改建议，以优化肾皮质肿瘤的管理。
小肾肿块的自然史尚不完全清楚。生长速度和肿瘤大小是预测肿瘤生物学的因素。目前，尚无特定的肿瘤标志物来确定初始风险或进展为转移性疾病；然而，正在对新的分子进行研究。美国泌尿外科学会提出的指南为 T1 肾皮质肿瘤的管理提供了一个正式的框架；然而，我们提出了一些具体的修改建议，并建议在评估患者的治疗方案时考虑这些建议。
