Urology Clinic, Department of Medical, Surgical and Health Science, University of Trieste, Trieste, Italy.
Department of Urology, Fundacion Instituto Valenciano Oncologia, Valencia, Spain.
World J Urol. 2021 Aug;39(8):2875-2882. doi: 10.1007/s00345-020-03581-6. Epub 2021 Jan 16.
To evaluate follow-up strategies for active surveillance of renal masses and to assess contemporary data.
We performed a comprehensive search of electronic databases (Embase, Medline, and Cochrane). A systematic review of the follow-up protocols was carried out. A total of 20 studies were included.
Our analysis highlights that most of the series used different protocols of follow-up without consistent differences in the outcomes. Most common protocol consisted in imaging and clinical evaluation at 3, 6, and 12 months and yearly thereafter. Median length of follow-up was 42 months (range 1-137). Mean age was 74 years (range 67-83). Of 2243 patients 223 (10%) died during the follow-up and 19 patients died of kidney cancer (0.8%). The growth rate was the most used parameter to evaluate disease progression eventually triggering delayed intervention. Maximal axial diameter was the most common method to evaluate growth rate. CT scan is the most used, probably because it is usually more precise than kidney ultrasound and more accessible than MRI. Performing chest X-ray at every check does not seem to alter the clinical outcome during AS.
The minimal cancer-specific mortality does not seem to correlate with the follow-up scheme. Outside of growth rate and initial size, imaging features to predict outcome of RCC during AS are limited. Active surveillance of SRM is a well-established treatment option. However, standardized follow-up protocols are lacking. Prospective, randomized, trials to evaluate the best follow-up strategies are pending.
评估肾肿瘤主动监测的随访策略并评估当代数据。
我们对电子数据库（Embase、Medline 和 Cochrane）进行了全面检索。对随访方案进行了系统评价。共纳入 20 项研究。
我们的分析表明，大多数系列使用了不同的随访方案，但其结果没有明显差异。最常见的方案包括在 3、6、12 个月及以后每年进行影像学和临床评估。中位随访时间为 42 个月（范围 1-137）。平均年龄为 74 岁（范围 67-83）。在 2243 名患者中，223 名（10%）在随访期间死亡，19 名死于肾癌（0.8%）。生长率是评估疾病进展最终引发延迟干预的最常用参数。最大轴向直径是最常用的评估生长率的方法。CT 扫描是最常用的，可能是因为它通常比肾脏超声更精确，比 MRI 更易获得。在 AS 期间，每次检查都进行胸部 X 光检查似乎不会改变临床结果。
最小的癌症特异性死亡率似乎与随访方案无关。除了生长率和初始大小外，用于预测 AS 期间 RCC 结局的影像学特征有限。主动监测肾肿瘤是一种成熟的治疗选择。然而，缺乏标准化的随访方案。有待进行前瞻性、随机对照试验来评估最佳的随访策略。
