Silvestri Antonio, Gavi Filippo, Sighinolfi Maria Chiara, Assumma Simone, Panio Enrico, Fettucciari Daniele, Pallotta Giuseppe, Schubert Or, Carerj Cristina, Ragonese Mauro, Russo Pierluigi, Bientinesi Riccardo, Foschi Nazario, Ciccarese Chiara, Iacovelli Roberto, Rocco Bernardo
Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy.
Department of Oncology, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy.
Int Braz J Urol. 2025 Sep-Oct;51(5). doi: 10.1590/S1677-5538.IBJU.2025.0203.
Renal cell carcinoma (RCC) ranks among the most prevalent malignancies worldwide, with a rising incidence attributed largely to the incidental detection of small renal masses (SRMs ≤ 4 cm) through widespread abdominal imaging. Historically managed with radical nephrectomy, treatment of SRMs has evolved significantly over recent decades. Partial nephrectomy has become the standard surgical approach, while active surveillance (AS) has emerged as a viable alternative for select patients, particularly those with comorbidities or limited life expectancy. AS involves serial imaging to monitor tumor progression, reserving intervention for signs of clinical advancement. This review synthesizes oncological outcomes and current management strategies for SRMs, comparing AS with immediate intervention. A comprehensive literature search (2005-2024) was performed across PubMed, Web of Science, and Scopus, complemented by an analysis of major international guidelines (EAU, AUA, ESMO, CUA, and Latin American Renal Cancer Group). All guidelines support AS for selected patients with cT1a tumors, though criteria vary. The AUA limits AS to tumors <2 cm, while only its guidelines define clear triggers for transitioning from AS to treatment. Imaging surveillance intervals and biopsy indications also differ, with broader support for renal mass biopsy prior to ablation but more selective use during AS. This review underscores the importance of individualized decision-making in SRM management and highlights areas of consensus and divergence among contemporary guidelines.
肾细胞癌（RCC）是全球最常见的恶性肿瘤之一，其发病率上升主要归因于通过广泛的腹部影像学检查偶然发现小肾肿块（SRMs≤4 cm）。过去，肾细胞癌主要通过根治性肾切除术进行治疗，但近几十年来，小肾肿块的治疗方法有了显著进展。部分肾切除术已成为标准的手术方法，而主动监测（AS）已成为某些特定患者（尤其是那些患有合并症或预期寿命有限的患者）可行的替代方案。主动监测包括通过系列影像学检查来监测肿瘤进展，仅在出现临床进展迹象时才进行干预。本综述综合了小肾肿块的肿瘤学结局和当前管理策略，并将主动监测与立即干预进行了比较。我们在PubMed、科学网和Scopus上进行了全面的文献检索（2005 - 2024年），并对主要国际指南（欧洲泌尿外科学会、美国泌尿外科学会、欧洲肿瘤内科学会、加拿大泌尿外科学会和拉丁美洲肾癌小组）进行了分析。所有指南均支持对部分cT1a期肿瘤患者进行主动监测，尽管标准各不相同。美国泌尿外科学会将主动监测限制在肿瘤<2 cm的患者，并且只有其指南明确规定了从主动监测过渡到治疗的触发因素。影像学监测间隔和活检指征也有所不同，对于消融前肾肿块活检的支持更为广泛，但在主动监测期间的使用则更为谨慎。本综述强调了在小肾肿块管理中进行个体化决策的重要性，并突出了当代指南之间的共识和分歧领域。
