Department of Surgical Oncology, Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia PA.
Department of Surgical Oncology, Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia PA; Department of Urology, Oregon Health and Science University, Portland, OR.
Urol Oncol. 2023 Mar;41(3):149.e11-149.e16. doi: 10.1016/j.urolonc.2022.09.019. Epub 2022 Dec 30.
To investigate the difference in renal function outcomes for patients with oncocytomas undergoing active surveillance (AS) vs. partial nephrectomy (PN).
We reviewed our institutional database for patients with biopsy/surgically confirmed oncocytoma from 2000-2020. The primary outcome was to assess for differences in renal function outcomes in patients undergoing AS vs. PN. We fit two generalized estimating equation (GEE) with an interaction term between follow up time and management strategy to predict 1) mean eGFR for patients managed with AS and PN and 2) the probability of progression to CKD stage III or greater.
We identified 114 eligible patients, of which 32 were managed with AS. Median follow-up was 21 months vs. 44 months for PN vs. AS patients. AS patients tended to be older (median: 72 years vs. 65 years, P<0.001) and have lower baseline renal function (median: eGFR: 71 mL/min/1.73m vs. 82 mL/min/1.73m, P<0.001) compared with PN patients. Renal mass size from baseline imaging was similar between patients undergoing PN vs. AS (2.8 cm vs. 2.9 cm, P=0.634). For patients undergoing PN vs. AS, there was not a significant difference in predicted longitudinal eGFR (-0.079, 95% CI -0.18-0.023, P=0.129) or predicted probability of progression to CKD stage III or greater (OR: 0.61, 95% CI: 0.16-2.33, P=0.47).
In our institutional dataset, patients undergoing AS or PN with an oncocytoma had similar long-term renal function outcomes. Given similar renal function outcomes in patients undergoing AS and PN, surgery should remain reserved for select patients with oncocytomas.
研究接受主动监测（AS）与部分肾切除术（PN）的肾嗜酸细胞瘤患者肾功能结局的差异。
我们回顾了 2000 年至 2020 年我们机构经活检/手术证实为肾嗜酸细胞瘤患者的病历数据库。主要结局是评估接受 AS 与 PN 的患者在肾功能结局方面的差异。我们使用了两个广义估计方程（GEE），并在随访时间和管理策略之间设置了交互项，以预测 1）接受 AS 和 PN 治疗的患者的平均 eGFR；2）进展为 CKD Ⅲ期或更高级别疾病的概率。
我们确定了 114 名符合条件的患者，其中 32 名接受 AS 治疗。PN 与 AS 患者的中位随访时间分别为 21 个月和 44 个月。AS 患者的年龄更大（中位数：72 岁 vs. 65 岁，P<0.001），基线肾功能更低（中位数：eGFR：71 mL/min/1.73m vs. 82 mL/min/1.73m，P<0.001）。接受 PN 与 AS 治疗的患者的基线影像学上的肿瘤大小相似（2.8 cm vs. 2.9 cm，P=0.634）。与接受 PN 治疗的患者相比，接受 AS 治疗的患者的预测纵向 eGFR 没有显著差异（-0.079，95%CI：-0.18-0.023，P=0.129）或进展为 CKD Ⅲ期或更高级别疾病的概率（OR：0.61，95%CI：0.16-2.33，P=0.47）。
在我们的机构数据集里，接受 AS 或 PN 治疗的肾嗜酸细胞瘤患者具有相似的长期肾功能结局。鉴于接受 AS 和 PN 治疗的患者的肾功能结局相似，手术应保留给有选择的肾嗜酸细胞瘤患者。
