Miller Brady L, Mankowski Gettle Lori, Van Roo Jason R, Ziemlewicz Timothy J, Best Sara L, Wells Shane A, Lubner Meghan G, Hinshaw J Louis, Lee Fred T, Nakada Stephen Y, Huang Wei, Abel E Jason
Department of Urology, University of Wisconsin, Madison, WI.
Department of Radiology, University of Wisconsin, Madison, WI.
Urology. 2018 Feb;112:92-97. doi: 10.1016/j.urology.2017.09.016. Epub 2017 Oct 10.
To compare oncological and procedural outcomes for renal oncocytic tumors treated with surgery, thermal ablation, or active surveillance.
Clinical and pathologic data were collected for consecutive patients with a histologic diagnosis of oncocytoma, oncocytic neoplasm, or chromophobe renal cell cancer (chRCC) from 2003 to 2016. Independent pathology and radiology reviews were performed for this study.
Of 171 patients, tumor histology included oncocytoma (n = 122), chRCC (n = 47), and oncocytic neoplasm not otherwise specified (n = 2). At the initial diagnosis, 67, 14, and 90 patients were treated with surgery, thermal ablation, and active surveillance. In 3 of 19 patients (16%) who had biopsy and subsequent surgery, diagnosis changed from oncocytoma to chRCC. The median follow-up was 39.9 months with no difference among choices of treatment modalities (P = .33). Of 90 patients who began active surveillance, 32 (36%) switched to active treatments (19 underwent thermal ablation and 13 underwent surgery). The median linear growth rate for patients on active surveillance was 1.2 mm/y. No patients who were managed with active surveillance developed metastatic renal cell cancer (mRCC). mRCC was identified in 3 patients and was the cause of death in 2 patients. Patients who developed metastatic disease presented with symptomatic tumors of >4 cm and were treated with immediate surgery. For oncocytic masses of ≤4 cm (n = 126), the 5-year cancer-specific survival was 100%.
Renal oncocytic neoplasms have favorable oncological outcomes. Active surveillance is safe and is the preferred management for small (≤4 cm) oncocytic renal tumors in selected patients.
比较手术、热消融或主动监测治疗肾嗜酸细胞瘤的肿瘤学和手术结局。
收集2003年至2016年组织学诊断为嗜酸细胞瘤、嗜酸细胞性肿瘤或嫌色肾细胞癌（chRCC）的连续患者的临床和病理数据。本研究进行了独立的病理和放射学评估。
171例患者中，肿瘤组织学类型包括嗜酸细胞瘤（n = 122）、chRCC（n = 47）和未另行指定的嗜酸细胞性肿瘤（n = 2）。初诊时，67例、14例和90例患者分别接受了手术、热消融和主动监测治疗。19例接受活检并随后接受手术的患者中，有3例（16%）的诊断从嗜酸细胞瘤变为chRCC。中位随访时间为39.9个月，不同治疗方式的选择之间无差异（P = 0.33）。90例开始主动监测的患者中，32例（36%）转为积极治疗（19例接受热消融，13例接受手术）。接受主动监测的患者的中位线性生长率为1.2 mm/年。接受主动监测的患者中无发生转移性肾细胞癌（mRCC）者。3例患者被诊断为mRCC，2例患者因mRCC死亡。发生转移性疾病的患者表现为直径>4 cm的有症状肿瘤，并立即接受了手术治疗。对于直径≤4 cm的嗜酸细胞性肿块（n = 126），5年癌症特异性生存率为100%。
肾嗜酸细胞性肿瘤具有良好的肿瘤学结局。主动监测是安全的，是部分患者中小（≤4 cm）肾嗜酸细胞性肿瘤的首选治疗方式。
