在肾嗜酸细胞瘤患者的主动监测期间，肾实质体积和功能的稳定性。
Stability of renal parenchymal volume and function during active surveillance of renal oncocytoma patients.
机构信息
Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, NY.
Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, NY.
出版信息
Urol Oncol. 2023 Apr;41(4):208.e15-208.e23. doi: 10.1016/j.urolonc.2023.01.006. Epub 2023 Feb 25.
INTRODUCTION AND OBJECTIVE
To evaluate whether significant loss in ipsilateral renal parenchymal volume (IRPV) and renal function occurs during active surveillance (AS) of renal oncocytoma (RO) patients.
METHODS
Renal function (estimated glomerular filtration rate, eGFR) dynamics were retrospectively analyzed in 32 consecutive biopsy-diagnosed RO patients managed with AS at a National Comprehensive Cancer Network institute. Three-dimensional kidney and tumor reconstructions were generated and IRPV was calculated using volumetry software (Myrian®) for all patients with manually estimated RO growth >+10 cm. GFR and IRPV were compared at AS initiation vs. the last follow-up using 2-sided paired t-tests. The correlation between change in IRPV and change in RO size or GFR was tested using a Spearman coefficient.
RESULTS
With median follow-up of 37 months, there was no significant change between initial vs. last eGFR (median 71.0 vs. 70.5 ml/min/1.73 m, P = 0.50; median change -3.0 ml/min/1.73 m). Among patients (n = 17) with RO growth >+10 cm during AS (median growth +28.6 cm, IQR +16.9- + 46.5 cm), IRPV generally remained stable (median change +0.5%, IQR -1.2%- + 1.2%), with only 2 cases surpassing 5% loss. No IRPV loss was detected among any patient within the top tertile of RO growth magnitude. RO growth magnitude did not correlate with loss of either IRPV (ρ = -0.30, P = 0.24) or eGFR (ρ = -0.16, P = 0.40), including among patient subsets with lower initial eGFR. Study limitations include a lack of long-term follow-up.
CONCLUSIONS
Volumetry is a promising novel tool to measure kidney and tumor tissue changes during AS. Our study using volumetry indicates that clinically significant loss of IRPV or eGFR is uncommon and unrelated to tumor growth among untreated RO patients with intermediate follow-up. These findings support that AS is in general functionally safe for RO patients, however longer study is needed to determine safety durability, particularly among uncommon ≥cT2 RO variants.
介绍和目的
评估在肾嗜酸细胞瘤（RO）患者的主动监测（AS）过程中，同侧肾实质体积（IRPV）和肾功能是否显著丧失。
方法
对国家综合癌症网络研究所经活检诊断为 RO 并接受 AS 治疗的 32 例连续患者的肾功能（估算肾小球滤过率，eGFR）动态进行回顾性分析。对所有 RO 生长手动估计 >+10 cm 的患者使用容积测量软件（Myrian®）生成三维肾脏和肿瘤重建，并计算 IRPV。使用双侧配对 t 检验比较 AS 开始时和最后一次随访时的 GFR 和 IRPV。使用 Spearman 系数测试 IRPV 变化与 RO 大小或 GFR 变化之间的相关性。
结果
中位随访 37 个月，初始 eGFR 与最后一次 eGFR 相比无显著差异（中位数 71.0 vs. 70.5 ml/min/1.73 m，P = 0.50；中位数变化 -3.0 ml/min/1.73 m）。在接受 AS 期间 RO 生长 >+10 cm 的患者（n = 17）中（中位生长 +28.6 cm，IQR +16.9- + 46.5 cm），IRPV 通常保持稳定（中位数变化 +0.5%，IQR -1.2%- + 1.2%），仅 2 例超过 5%的损失。在 RO 生长幅度最高的三分位患者中，未检测到任何患者的 IRPV 丢失。RO 生长幅度与 IRPV（ρ = -0.30，P = 0.24）或 eGFR（ρ = -0.16，P = 0.40）的损失均无相关性，包括初始 eGFR 较低的患者亚组。研究局限性包括缺乏长期随访。
结论
体积测量是一种有前途的新型工具，可用于测量 AS 期间肾脏和肿瘤组织的变化。我们使用体积测量的研究表明，在接受中间随访的未经治疗的 RO 患者中，临床显著的 IRPV 或 eGFR 损失并不常见，与肿瘤生长无关。这些发现支持 AS 通常对 RO 患者是安全的，但需要更长时间的研究来确定安全性的持久性，特别是在罕见的≥cT2 RO 变体中。
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