Department of Medicine and Geriatrics, Ruttonjee Hospital, Wan Chai, Hong Kong.
Department of Medicine, Queen Mary Hospital, Pokfulam, Hong Kong.
Pituitary. 2022 Apr;25(2):258-266. doi: 10.1007/s11102-021-01194-9. Epub 2021 Nov 22.
The primary objective was to investigate the clinical presentation, hormonal dysfunction, imaging characteristics and natural history of RCCs that were managed conservatively. Secondary objective was to identify factors associated with cyst progression.
A retrospective review of patients with the clinical diagnosis of RCC-identified from word search from radiology reports that were followed up from January 1999 to March 2019 was performed. The demographics, clinical data, radiological features and outcomes were reviewed and analyzed.
105 patients were identified with a median follow up of 6 years. 68 patients (64.8%) were managed conservatively from diagnosis till last follow up while 37 patients (35.2%) underwent surgery, with 26 operated at time of diagnosis and 11 operated upon monitoring. For patients managed conservatively from diagnosis till last follow up, incidental finding was the most common presentation. 19.1% had either one or more axes of hormonal dysfunction, with hypogonadism and hypocortisolemia being the commonest ones. Imaging features were variable. 66.2% of patients had T2W hyperintensity on MRI. Pathognomonic feature of intracystic nodule was present in only 14.7% of patients. Among the 79 patients with repeated MRI imaging (68 from conservative group and 11 from surgical group), 32.9% of patients developed cyst progression while 67.1% had either static disease or regression in size of RCC. Median time to progression of cyst was 14 months. Longer median follow up duration and presence of pituitary stalk displacement at presentation were associated with cyst progression. Only one patient developed new endocrine dysfunction.
2/3 of the RCCs had static disease or even regression in the size of the cyst. They rarely gave rise to additional endocrine dysfunction by adopting observant approach. Cyst progression was demonstrated in 1/3 of patients. Conservative treatment remained a reasonable treatment for patients without significant symptoms.
本研究旨在探讨经保守治疗的肾嫌色细胞癌（RCC）患者的临床表现、激素功能障碍、影像学特征和自然病程。次要目的是确定与囊肿进展相关的因素。
对 1999 年 1 月至 2019 年 3 月期间通过放射学报告中的文字搜索发现的临床诊断为 RCC 的患者进行回顾性分析。回顾并分析了患者的人口统计学、临床数据、影像学特征和结局。
共纳入 105 例患者，中位随访时间为 6 年。68 例（64.8%）患者从诊断到最后一次随访均接受保守治疗，37 例（35.2%）患者接受了手术治疗，其中 26 例在诊断时手术，11 例在监测时手术。对于从诊断到最后一次随访均接受保守治疗的患者，偶然发现是最常见的表现。19.1%的患者存在 1 个或多个激素轴功能障碍，其中以性腺功能减退和皮质醇减少最为常见。影像学特征多种多样。66.2%的患者 MRI 上 T2W 呈高信号。仅 14.7%的患者存在囊内结节的特征性表现。在 79 例接受重复 MRI 检查的患者（68 例来自保守治疗组，11 例来自手术治疗组）中，32.9%的患者出现囊肿进展，67.1%的患者的 RCC 囊肿大小保持稳定或出现缩小。囊肿进展的中位时间为 14 个月。较长的中位随访时间和存在垂体柄移位与囊肿进展相关。仅 1 例患者出现新的内分泌功能障碍。
2/3的 RCC 患者的囊肿保持稳定或甚至缩小。通过观察的方法，它们很少引起额外的内分泌功能障碍。1/3的患者出现囊肿进展。对于没有明显症状的患者，保守治疗仍然是一种合理的治疗方法。
