Finelli Antonio, Cheung Douglas C, Al-Matar Ashraf, Evans Andrew J, Morash Christopher G, Pautler Stephen E, Siemens D Robert, Tanguay Simon, Rendon Ricardo A, Gleave Martin E, Drachenberg Darrel E, Chin Joseph L, Fleshner Neil E, Haider Masoom A, Kachura John R, Sykes Jenna, Jewett Michael A S
Division of Urology, Department of Surgery, Princess Margaret Cancer Centre and the University Health Network, University of Toronto, Toronto, ON, Canada.
Division of Urology, Department of Surgery, Princess Margaret Cancer Centre and the University Health Network, University of Toronto, Toronto, ON, Canada.
Eur Urol. 2020 Sep;78(3):460-467. doi: 10.1016/j.eururo.2020.06.053. Epub 2020 Jul 14.
Most reports of active surveillance (AS) of small renal masses (SRMs) lack biopsy confirmation, and therefore include benign tumors and different subtypes of renal cell carcinoma (RCC).
We compared the growth rates and progression of different histologic subtypes of RCC SRMs (SRM) in the largest cohort of patients with biopsy-characterized SRMs on AS.
DESIGN, SETTING, AND PARTICIPANTS: Data from patients in a multicenter Canadian trial and a Princess Margaret cohort were combined to include 136 biopsy-proven SRM lesions managed by AS, with treatment deferred until progression or patient/surgeon decision.
Growth curves were estimated from serial tumor size measures. Tumor progression was defined by sustained size ≥4 cm or volume doubling within 1 yr.
Median follow-up for patients who remained on AS was 5.8 yr (interquartile range 3.4-7.5 yr). Clear cell RCC SRMs (SRM) grew faster than papillary type 1 SRMs (0.25 and 0.02 cm/yr on average, respectively, p = 0.0003). Overall, 60 SRM lesions progressed: 49 (82%) by rapid growth (volume doubling), seven (12%) increasing to ≥4 cm, and four (6.7%) by both criteria. Six patients developed metastases, and all were of clear cell RCC histology. Limitations include the use of different imaging modalities and a lack of central imaging review.
Tumor growth varies between histologic subtypes of SRM and among SRM, which likely reflects individual host and tumor biology. Without validated biomarkers that predict this variation, initial follow-up of histologically characterized SRMs can inform personalized treatment for patients on AS.
Many small kidney cancers are suitable for surveillance and can be monitored over time for change. We demonstrate that different types of kidney cancers grow at different rates and are at different risks of progression. These results may guide better personalized treatment.
大多数关于小肾肿块（SRM）主动监测（AS）的报告缺乏活检证实，因此包括良性肿瘤和不同亚型的肾细胞癌（RCC）。
在最大的一组经活检特征化的接受主动监测的SRM患者中，我们比较了不同组织学亚型的RCC SRM的生长率和进展情况。
设计、设置和参与者：来自加拿大一项多中心试验和玛格丽特公主队列研究的患者数据被合并，共纳入136个经活检证实的接受主动监测的SRM病灶，治疗推迟至病情进展或患者/外科医生做出决定。
根据系列肿瘤大小测量值估计生长曲线。肿瘤进展定义为肿瘤大小持续≥4 cm或在1年内体积翻倍。
继续接受主动监测的患者的中位随访时间为5.8年（四分位间距3.4 - 7.5年）。透明细胞RCC SRM生长速度比1型乳头状SRM快（平均分别为每年0.25和0.02 cm，p = 0.0003）。总体而言，60个SRM病灶进展：49个（82%）通过快速生长（体积翻倍），7个（12%）增大至≥4 cm，4个（6.7%）符合两者标准。6例患者发生转移，均为透明细胞RCC组织学类型。局限性包括使用了不同的成像方式且缺乏中心成像评估。
SRM的不同组织学亚型之间以及SRM内部的肿瘤生长情况各不相同，这可能反映了个体宿主和肿瘤生物学特性。在没有可预测这种差异的经过验证的生物标志物的情况下，对经组织学特征化的SRM进行初始随访可为接受主动监测的患者的个性化治疗提供依据。
许多小肾癌适合进行监测，并且可以随时间监测其变化。我们证明不同类型的肾癌生长速度不同，进展风险也不同。这些结果可能有助于更好地进行个性化治疗。
