American Urological Association Education and Research, Inc., Linthicum, Maryland.
J Urol. 2017 Sep;198(3):520-529. doi: 10.1016/j.juro.2017.04.100. Epub 2017 May 4.
This AUA Guideline focuses on evaluation/counseling and management of adult patients with clinically localized renal masses suspicious for cancer, including solid-enhancing tumors and Bosniak 3/4 complex-cystic lesions.
Systematic review utilized research from the Agency for Healthcare Research and Quality and additional supplementation by the authors and consultant methodologists. Evidence-based statements were based on body of evidence strength Grade A/B/C (Strong/Moderate/Conditional Recommendations, respectively) with additional statements presented as Clinical Principles or Expert Opinions.
Great progress has been made since the previous guidelines on management of localized renal masses were released (2009). The current guidelines provide updated, evidence-based recommendations regarding evaluation/counseling of patients with clinically localized renal masses, including the evolving role of renal mass biopsy. Given great variability of clinical, oncologic and functional characteristics, index patients are not utilized and the panel advocates individualized counseling/management. Management options (partial nephrectomy/radical nephrectomy/thermal ablation/active surveillance) are reviewed including recent data about comparative effectiveness and potential morbidities. Oncologic issues are prioritized while recognizing that functional outcomes are of great importance for survivorship for most patients with localized kidney cancer. A more restricted role for radical nephrectomy is recommended following well-defined selection criteria. Priority for partial nephrectomy is recommended for clinical T1a lesions, along with selective use of thermal ablation, particularly for tumors ≤3.0 cm. Important considerations for shared decision-making about active surveillance are explicitly defined.
Several factors should be considered during counseling/management of patients with clinically localized renal masses, including general health/comorbidities, oncologic potential of the mass, pertinent functional issues and relative efficacy/potential morbidities of various management strategies.
本 AUA 指南侧重于评估/咨询和管理疑似癌症的成人局灶性肾肿块患者，包括实体强化肿瘤和 Bosniak 3/4 型复杂囊性病变。
系统评价利用了美国医疗保健研究与质量局的研究，并由作者和顾问方法学家进行了额外的补充。基于证据强度等级 A/B/C 的循证陈述（分别为强/中度/条件推荐），并提出了其他陈述作为临床原则或专家意见。
自上次发布局灶性肾肿块管理指南以来（2009 年），已经取得了很大进展。本指南提供了关于局灶性肾肿块患者评估/咨询的更新、基于证据的建议，包括肾肿块活检的作用不断演变。鉴于临床、肿瘤学和功能特征的巨大差异，本指南不使用索引患者，而是提倡个体化咨询/管理。审查了管理选项（部分肾切除术/根治性肾切除术/热消融/主动监测），包括比较有效性和潜在发病率的最新数据。在认识到对于大多数局灶性肾癌患者，功能结果对生存质量非常重要的同时，优先考虑肿瘤学问题。建议在明确选择标准的情况下，为根治性肾切除术提供更有限的作用。建议对临床 T1a 病变优先进行部分肾切除术，并选择性使用热消融术，特别是对于≤3.0cm 的肿瘤。明确定义了关于主动监测的共同决策的重要考虑因素。
在局灶性肾肿块患者的咨询/管理过程中，应考虑多个因素，包括一般健康/合并症、肿块的肿瘤学潜力、相关的功能问题以及各种管理策略的相对疗效/潜在发病率。
