Hwang Christopher K, Ogan Kenneth, Pattaras John, Master Viraj A
Department of Urology, Emory University School of Medicine, Atlanta, Georgia 30322, USA.
Can J Urol. 2010 Dec;17(6):5459-64.
The detection rate of incidental renal masses is increasing. Historically these masses have been treated with extirpative surgery. Hence, there is little information on the growth rate, metastatic potential, and natural history of renal tumors. Through active surveillance, we study the natural history of renal masses and determine their growth rate and risk for metastasis.
From 1997 to 2007, active surveillance was offered to select patients with renal masses with no evidence of metastasis. Based on imaging studies from the initial diagnosis to the last follow up, tumor growth rates were determined.
Forty-six patients were studied for a total of 58 masses. Mean age of patients at diagnosis was 64.3 years. Mean Charlson comorbidity score was 5.2 (median 5, range 2-13). Mean follow up period was 22 months (median 17, range 5-121). Mean initial tumor volume was 6.6 cm3 (median 2.7, range 0.03-43.2). Mean growth rate was 1.9 cm3/yr (median 0.1, range -3.8-27.9), and 6.8% had a volume doubling time of less than 1 year. No patient developed radiographic evidence of metastasis or died during follow up. Thirteen patients (15 masses) went onto operative intervention at a mean follow up of 19 months (median 18, range 4-36); 10/15 (67%) revealed renal cell carcinoma and 5/15 (33%) were benign.
In our cohort, negligible growth rates are observed in the vast majority of renal masses undergoing active surveillance, and thus, a carefully selected patient population may be safely managed with active surveillance with serial imaging.
偶然发现的肾肿块的检出率正在上升。从历史上看，这些肿块一直通过根治性手术治疗。因此，关于肾肿瘤的生长速度、转移潜能和自然病史的信息很少。通过主动监测，我们研究肾肿块的自然病史，并确定其生长速度和转移风险。
从1997年到2007年，对选定的无转移证据的肾肿块患者进行主动监测。根据从初始诊断到最后随访的影像学研究，确定肿瘤生长速度。
对46例患者共58个肿块进行了研究。患者诊断时的平均年龄为64.3岁。平均查尔森合并症评分5.2（中位数5，范围2 - 13）。平均随访期为22个月（中位数17，范围5 - 121）。平均初始肿瘤体积为6.6 cm³（中位数2.7，范围0.03 - 43.2）。平均生长速度为1.9 cm³/年（中位数0.1，范围 - 3.8 - 27.9），6.8%的患者体积倍增时间小于1年。随访期间无患者出现转移的影像学证据或死亡。13例患者（15个肿块）在平均随访19个月（中位数18，范围4 - 36）时接受了手术干预；15个肿块中有10个（67%）为肾细胞癌，5个（33%）为良性。
在我们的队列中，绝大多数接受主动监测的肾肿块生长速度可忽略不计，因此，经过精心挑选的患者群体可通过连续影像学检查进行安全的主动监测管理。
