Department of Urology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
World J Urol. 2010 Jun;28(3):275-81. doi: 10.1007/s00345-010-0516-8. Epub 2010 Feb 23.
Recently, small renal masses (SRMs) (< or =4 cm) are found more frequently, especially in the elderly and co-morbid patients. Standard treatment for SRMs is nephron-sparing surgery (NSS). New techniques like energy ablation and surveillance have been introduced.
Overview of treatment options for SRMs, based mainly on the meta-analyses available for NSS, cryoablation, radio-frequency ablation (RFA), and surveillance.
NSS for SRMs is the standard therapy with excellent cancer-specific survival rates up to 97%. Cryoablation was mainly performed laparoscopically, and RFA mainly percutaneously. Pretreatment biopsies were used frequently for cryoablation (80%) and less frequently for RFA (50%). Primary failure rate for cryoablation was 4.8% and for RFA 13%. Major complication rates for both procedures are around 5%. Based on 6-month post-ablative biopsies, non-contrast enhancement seems to be an effective surrogate marker after cryoablation, but not after RFA. Follow-up after energy ablation is too short to draw final conclusion. Data on surveillance are based on small, retrospective data with insufficient follow-up. Growth patterns during follow-up do not correlate with the underlying tumour entity.
Standard therapy for SRMs is still NSS. Energy ablation should be reserved for the elderly patients with co-morbidities and surveillance for the elderly and infirm patients.
最近，越来越多的人发现了小的肾肿瘤（SRMs）（<=4 厘米），尤其是在老年患者和合并症患者中。SRMs 的标准治疗方法是保留肾单位手术（NSS）。目前已经引入了一些新技术，如能量消融和监测。
基于对 NSS、冷冻消融术、射频消融术（RFA）和监测的可用荟萃分析，对 SRMs 的治疗选择进行概述。
NSS 是治疗 SRMs 的标准疗法，其癌症特异性生存率高达 97%。冷冻消融术主要在腹腔镜下进行，RFA 主要经皮进行。冷冻消融术（80%）和 RFA（50%）术前常进行活检。冷冻消融术的原发失败率为 4.8%，RFA 为 13%。两种方法的主要并发症发生率均约为 5%。基于消融后 6 个月的活检，无增强扫描似乎是冷冻消融后的有效替代标志物，但不是 RFA 后的替代标志物。能量消融后的随访时间太短，无法得出最终结论。监测数据基于小型回顾性数据，随访时间不足。在随访过程中肿瘤的生长模式与肿瘤实体不相关。
SRMs 的标准治疗方法仍然是 NSS。对于有合并症的老年患者，应保留能量消融术；对于老年和体弱患者，应进行监测。
