James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland.
Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland.
Cancer. 2016 Nov 15;122(21):3267-3276. doi: 10.1002/cncr.30268. Epub 2016 Aug 10.
Solid renal masses and cystic lesions with solid components are suspicious for renal cell carcinoma. Without an effective screening test, composite models and nomograms rely on patient and tumor characteristics to stratify the risk of benign disease versus malignant disease. To guide decisions about the use of renal mass sampling or excision, a systematic review and meta-analysis of the ability of composite models to predict the likelihood of malignancy on the basis of preoperative clinical variables was performed. MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched from January 1, 1997, through May 1, 2015, according to the Preferred Reporting Items for Systematic Review and Meta-Analyses statement. Composite models necessarily included imaging results and at least 1 element from the following to be compared with surgical pathology: demographic characteristics, clinical characteristics, and blood or urine tests. Two independent reviewers screened citations and extracted data. Quality Assessment Tool for Diagnostic Accuracy Studies 2 was used to assess the risk of bias. The strength of evidence was graded with the scheme recommended by Methods Guide for Effectiveness and Comparative Effectiveness Reviews. Twenty studies (12,149 patients) were included in this review. The only significant predictors of malignancy in the composite models were tumor size (effect size, 1.33-fold increased risk per centimeter; 95% confidence interval [CI], 1.22-1.43) and male sex (effect size, 2.71; 95% CI, 2.39-3.02). The results were inconclusive or not significant for tumor characteristics, age, body mass index, and incidental presentation. In conclusion, composite models currently have a limited ability to distinguish malignant renal masses from benign renal masses, with increased tumor size and male sex associated with malignancy. Cancer 2016;122:3267-3276. © 2016 American Cancer Society.
实性肾脏肿块和伴有实性成分的囊性病变提示肾细胞癌。在没有有效筛查试验的情况下，综合模型和列线图依赖于患者和肿瘤特征来分层良性疾病与恶性疾病的风险。为了指导关于使用肾肿块取样或切除的决策，我们对术前临床变量基础上综合模型预测恶性肿瘤可能性的能力进行了系统评价和荟萃分析。根据系统评价和荟萃分析的首选报告项目，从 1997 年 1 月 1 日至 2015 年 5 月 1 日，在 MEDLINE、EMBASE 和 Cochrane 对照试验中心注册库中进行了检索。综合模型必然包括影像学结果和至少以下一个与手术病理结果相比较的元素：人口统计学特征、临床特征、血液或尿液检查。两名独立的审查员筛选引文并提取数据。使用诊断准确性研究的质量评估工具 2 来评估偏倚风险。证据强度根据方法指南的推荐进行分级。这项综述共纳入了 20 项研究（12149 例患者）。综合模型中唯一有统计学意义的恶性肿瘤预测因子是肿瘤大小（效应量，每厘米增加 1.33 倍的风险；95%置信区间[CI]，1.22-1.43）和男性（效应量，2.71；95%CI，2.39-3.02）。肿瘤特征、年龄、体重指数和偶然发现等方面的结果不一致或无统计学意义。总之，综合模型目前对区分恶性和良性肾肿块的能力有限，肿瘤大小增加和男性与恶性肿瘤相关。癌症 2016；122:3267-3276。©2016 美国癌症协会。
