Bahouth Zaher, Halachmi Sarel, Meyer Gil, Avitan Ofir, Moskovitz Boaz, Nativ Ofer
Department of Urology, Bnai Zion Medical Center, 3339414 Haifa, Israel ; Faculty of Medicine, Technion-Israel Institute of Technology, 3200003 Haifa, Israel.
Adv Urol. 2015;2015:692014. doi: 10.1155/2015/692014. Epub 2015 Apr 15.
Aim. To describe the natural history of small renal mass on active surveillance and identify parameters that could help in predicting the need for intervention in patients with small renal masses undergoing active surveillance. We also discuss the need for renal biopsy in the management of these patients. Methods. A retrospective analysis of 78 renal masses ≤4 cm diagnosed at our Urology Department at Bnai Zion Medical Center between September 2003 and March 2012. Results. Seventy patients with 78 small renal masses were analyzed. The mean age at diagnosis was 68 years (47-89). The mean follow-up period was 34 months (12-112). In 54 of 78 masses there was a growth of at least 2 mm between imaging on last available follow-up and diagnosis. Eight of the 54 (15%) masses which grew in size underwent a nephron-sparing surgery, of which two were oncocytomas and six were renal cell carcinoma. Growth rate and mass diameter on diagnosis were significantly greater in the group of patients who underwent a surgery. Conclusions. Small renal masses might eventually be managed by active surveillance without compromising survival or surgical approach. All masses that were eventually excised underwent a nephron-sparing surgery. None of the patients developed metastases.
目的。描述接受主动监测的小肾肿块的自然病史，并确定有助于预测接受主动监测的小肾肿块患者是否需要干预的参数。我们还讨论了这些患者管理中肾活检的必要性。方法。对2003年9月至2012年3月期间在贝纳伊锡安医疗中心泌尿外科诊断出的78个直径≤4厘米的肾肿块进行回顾性分析。结果。分析了70例患有78个小肾肿块的患者。诊断时的平均年龄为68岁（47 - 89岁）。平均随访期为34个月（12 - 112个月）。在78个肿块中的54个中，在最后一次可用随访的影像学检查与诊断之间至少有2毫米的生长。54个增大的肿块中有8个（15%）接受了保留肾单位手术，其中2个是嗜酸细胞瘤，6个是肾细胞癌。接受手术的患者组中，诊断时的生长率和肿块直径明显更大。结论。小肾肿块最终可能通过主动监测进行管理，而不会影响生存率或手术方式。所有最终切除的肿块都接受了保留肾单位手术。没有患者发生转移。
