Edwards Francesco, Fanshawe Jack B, Neves Joana, Aitchison Michael, El-Sheikh Soha, Hughes-Hallett Archie, Marous Ahmed, Mumtaz Faiz, Withington John, Patki Prasad, Barod Ravi, Silva Pedro, Varley Rebecca, To Wilson, Bex Axel, Warren Hannah, Tran Maxine G B
Faculty of Life Sciences and Medicine, King's College London, London, UK.
Guy's and St Thomas' NHS Foundation Trust, London, UK.
BJU Int. 2025 Oct;136(4):590-601. doi: 10.1111/bju.16832. Epub 2025 Jul 7.
Current guidelines recommend active surveillance, surgery, and ablation all as acceptable management strategies for renal oncocytoma, but there is growing concern about overtreatment. Our aim was to report the natural history of treated and untreated renal oncocytoma to inform clinical guidelines and shared decision-making.
A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). We systematically reviewed MEDLINE, EMBASE, CENTRAL and Clinicaltrials.gov from inception to 18 August 2023. Studies that reported outcomes during follow-up for adult patients with treated and untreated histologically confirmed renal oncocytoma were included. The Joanna Briggs Institute tool was used to assess risk of bias for included studies. We present a narrative review and meta-analysis.
There are no reports of distant metastases or disease-related death for oncocytoma on active surveillance. Most oncocytomas on surveillance show limited growth (<2 mm/year) and minimal renal function decline (-1 mL/min/1.73m/year). A significant minority (14%) transition to active treatment, most often for tumour growth. Concordance between biopsy and surgical pathology was high (89%). Metastatic oncocytoma and disease-related death after treatment was negligible, and exclusively in reports using historic diagnostic criteria defined prior to the World Health Organisation 1998 classification, and therefore likely including eosinophilic renal cell carcinomas.
Active surveillance of oncocytoma is oncologically safe and allows patients to avoid the risk of morbidity and mortality with treatment. Imaging surveillance after active treatment can be safely omitted. The literature would benefit from prospective cohort studies of oncocytomas on surveillance, reporting surveillance protocols, and clinical outcomes including reasons for transition to active treatment.
当前指南推荐主动监测、手术和消融均为肾嗜酸细胞瘤可接受的管理策略，但对过度治疗的担忧日益增加。我们的目的是报告治疗和未治疗的肾嗜酸细胞瘤的自然病程，以为临床指南和共同决策提供依据。
根据系统评价和Meta分析的首选报告项目（PRISMA）进行系统评价。我们系统检索了MEDLINE、EMBASE、CENTRAL和Clinicaltrials.gov，检索时间从数据库建立至2023年8月18日。纳入报告经组织学证实的治疗和未治疗的成年肾嗜酸细胞瘤患者随访结果的研究。使用乔安娜·布里格斯研究所工具评估纳入研究的偏倚风险。我们进行了叙述性综述和Meta分析。
主动监测的嗜酸细胞瘤无远处转移或疾病相关死亡的报告。大多数接受监测的嗜酸细胞瘤生长有限（<2毫米/年），肾功能下降极小（-1毫升/分钟/1.73平方米/年）。少数（14%）转变为积极治疗，最常见的原因是肿瘤生长。活检与手术病理的一致性较高（89%）。治疗后转移性嗜酸细胞瘤和疾病相关死亡可忽略不计，且仅出现在使用1998年世界卫生组织分类之前定义的历史诊断标准的报告中，因此可能包括嗜酸性肾细胞癌。
对嗜酸细胞瘤进行主动监测在肿瘤学上是安全的，可使患者避免治疗带来的发病和死亡风险。主动治疗后的影像监测可安全省略。关于接受监测的嗜酸细胞瘤的前瞻性队列研究、报告监测方案以及包括转变为积极治疗原因在内的临床结果的文献将有所助益。
