Department of Urology, Churchill Hospital, Headington, Oxford, UK.
BJU Int. 2012 Nov;110(9):1270-5. doi: 10.1111/j.1464-410X.2012.11130.x. Epub 2012 May 4.
Study Type - Therapy (case series) Level of Evidence 4. What's known on the subject? and What does the study add? Active surveillance of small renal masses has traditionally been reserved for elderly patients deemed unfit for surgery or ablation. There is increasing evidence showing the safety of active surveillance in the management of small renal masses. In this retrospective study we compared outcomes for patients with small renal masses managed with active surveillance, radical nephrectomy and partial nephrectomy. We showed that active surveillance was safe and appeared as effective as immediate surgery in the management of small renal tumours.
• To compare the oncological outcomes of active surveillance (AS), radical nephrectomy (RN) and partial nephrectomy (PN) in the management of T1a small renal masses (SRMs).
• At present AS is used in the treatment of SRMs in elderly patients with multiple co-morbidities or in those who decline surgery. • We identified all patients with T1a SRMs managed with RN, PN or AS. • Retrospective data were collected from patient case records with survival data and cause of death cross-referenced with the Oxford Cancer Intelligence Unit.
• A total of 202 patients with 234 T1a SRMs (solid or Bosniak IV) were identified; 71 patients were managed with AS, 41 with an RN and 90 by PN. • Over a median follow-up of 34 months the mean growth rate on AS was 0.21 cm/year with 53% of SRMs managed with AS showing negative or zero growth. • No statistically significant difference was observed in overall (OS) and cancer-specific (CSS) survival for AS, RN and PN (AS-CSS 98.6%, AS-OS 83%; RN-CSS 92.6%, RN-OS 80.4%; PN-CSS 96.6%, PN-OS 90.0%).
• Active surveillance of SRMs offers oncological efficacy equivalent to surgery in the short/intermediate term. • The results of this study support a multicentre prospective randomized controlled trial designed to compare the oncological efficacy of AS and surgery.
• 比较主动监测（AS）、根治性肾切除术（RN）和部分肾切除术（PN）治疗 T1a 小肾肿瘤（SRM）的肿瘤学结果。
• 目前，AS 用于治疗老年患者的 SRM，这些患者有多种合并症或拒绝手术。• 我们确定了所有接受 RN、PN 或 AS 治疗的 T1a SRM 患者。• 从患者病历中收集回顾性数据，生存数据与牛津癌症情报单位的死亡原因进行交叉参照。
• 共确定了 202 例 234 个 T1a SRM（实体或 Bosniak IV）患者；71 例患者接受 AS 治疗，41 例患者接受 RN 治疗，90 例患者接受 PN 治疗。• 在中位数为 34 个月的随访中，AS 组的平均增长率为 0.21cm/年，53%的 AS 治疗的 SRM 表现为阴性或零增长。• AS、RN 和 PN 在总生存（OS）和癌症特异性生存（CSS）方面无统计学差异（AS-CSS 98.6%，AS-OS 83%；RN-CSS 92.6%，RN-OS 80.4%；PN-CSS 96.6%，PN-OS 90.0%）。
• AS 治疗 SRM 在短期/中期提供了与手术相当的肿瘤学疗效。• 这项研究的结果支持一项多中心前瞻性随机对照试验，旨在比较 AS 和手术的肿瘤学疗效。
