Department of Urology, Columbia University Medical Center, New York, NY 10032, USA.
Urology. 2011 Apr;77(4):787-91. doi: 10.1016/j.urology.2010.09.031. Epub 2010 Dec 16.
To present our experience with patients who elected active surveillance for renal cortical neoplasms (RCNs) with ≥5 years of follow-up. Few data are available regarding the long-term natural history of RCNs during surveillance.
We retrospectively reviewed our urologic oncology database and identified 44 patients with 51 RCNs who had received active surveillance for >5 years of follow-up. The patient and tumor characteristics and tumor growth rate and overall survival data were evaluated.
The median patient age was 71.7 years (range 55-92), with 32 patients (72.7%) having a Charlson comorbidity index of ≥2. The median tumor size was 2.67 cm (range 0.9-8.6) at diagnosis. Biopsy was performed in 17 patients (38.6%). Of these 17 patients, clear cell renal cell carcinoma was diagnosed in 15 and papillary renal cell carcinoma in 2 patients. The median follow-up was 77.1 months (range 60-137), and the median growth rate was 0.15 cm/y. Of these patients, 2 (4.5%) required delayed intervention. One underwent laparoscopic radical nephrectomy because of a high tumor growth rate, and one elected to withdraw from active surveillance because of personal anxiety, despite having a stable tumor size for 72 months. The latter patient underwent laparoscopic renal cryoablation. Histopathologic examination revealed clear cell renal cell carcinoma in both cases. No metastases or cancer-related deaths occurred in our cohort; 1 patient died of cardiovascular disease.
Most RCNs undergoing surveillance for >5 years grew slowly. The metastatic potential appeared minimal in patients who demonstrated low or absent tumor growth for a long period.
介绍我们对接受主动监测的≥5 年随访的肾皮质肿瘤（RCN）患者的经验。关于监测期间 RCN 的长期自然史，可用的数据很少。
我们回顾性地审查了我们的泌尿外科肿瘤数据库，并确定了 44 例接受>5 年随访的 51 例 RCN 患者。评估了患者和肿瘤特征、肿瘤生长速度和总生存率数据。
中位患者年龄为 71.7 岁（范围 55-92），32 例（72.7%）患者Charlson 合并症指数≥2。诊断时肿瘤大小中位数为 2.67cm（范围 0.9-8.6）。17 例（38.6%）患者行活检。这 17 例患者中，15 例诊断为透明细胞肾细胞癌，2 例诊断为乳头状肾细胞癌。中位随访时间为 77.1 个月（范围 60-137），中位生长速度为 0.15cm/y。这些患者中有 2 例（4.5%）需要延迟干预。1 例行腹腔镜根治性肾切除术，因为肿瘤生长速度较快，1 例因个人焦虑而选择退出主动监测，尽管肿瘤大小稳定 72 个月。后者患者接受了腹腔镜肾冷冻消融术。组织病理学检查显示，这两例均为透明细胞肾细胞癌。我们的队列中没有发生转移或癌症相关死亡；1 例患者死于心血管疾病。
大多数接受>5 年监测的 RCN 生长缓慢。对于长期肿瘤生长缓慢或无肿瘤生长的患者，转移潜能似乎很小。
