Predicting growth of solid renal masses under active surveillance
Predicting growth of solid renal masses under active surveillance
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DOI：
10.1016/j.urolonc.2008.03.010
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发表时间：
2008-09-01
影响因子：
2.7
通讯作者：
Uzzo, Robert G.
中科院分区：
文献类型：
--
作者：
Crispen, Paul L.;Wong, Yu-Ning;Uzzo, Robert G.
目的：未经治疗的实体强化肾肿瘤的自然病史和生长速度正在通过积极的监测系列来确定。对非手术候选或拒绝手术治疗的患者进行的系列放射学评估提供了一个机会来描述未经治疗的增强型肾肿瘤的生长情况。在这里，我们评估了在观察期间可能有助于预测放射学增长的因素。材料和方法：我们回顾了我们的肾癌数据库，以增强经过至少12个月的放射学观察的肾脏肿块。研究的变量包括患者的年龄、性别、发病时的病变大小、放射学肿瘤特征、积极监测的持续时间、线性增长率、手术病理、新发肾肿瘤的发展和分期进展。结果：经过至少12个月的积极监测，109例患者的124个零星强化肾肿瘤被确定。患者的平均年龄为73岁(平均69.8岁)。范围35-87)-72%(78/109)为男性。主动监测的中位持续时间为26个月(平均33.4个月，范围12-156个月)。9%(10/109)的患者出现多灶性病变，占所有肿瘤的20%(25/124)。肿瘤大小中位数为2.0厘米(平均2.61，范围0.4-12.0)。总体肿瘤生长速度的中位数为0.21厘米/年(平均0.28厘米/年)。范围1.4-2.47)。观察到的线性增长率与患者的年龄、性别、肿瘤大小无关。多灶性和放射学特征(实性与囊性)，P>；0.05。在开始积极监测的患者中，36%(39/109)最终接受了明确的治疗。在接受治疗的患者中，90%(35/39)出现恶性病理。在继续积极监测的患者中[%(70/109)]，2.9%(2/70)发生新生肾脏病变，1.4%(1/70)发生转移性疾病。结论：目前还没有发现肿瘤生长或疾病进展的临床预测因素。在短期内发展为进行性疾病的风险似乎很低。在对原本可接受的手术候选人提供积极监测之前，需要疾病进展的临床和分子标志物。(C)2008 Elsevier Inc.保留所有权利。
Objectives: The natural history and growth rates of untreated solid enhancing renal tumors is being defined through active surveillance series. Serial radiographic evaluation of patients who are not surgical candidates or refuse surgical treatment provides an opportunity to characterize the growth of untreated enhancing renal tumors. Here we evaluate factors that may help predict radiographic growth during observation.Materials and methods: We reviewed our renal cancer database for enhancing renal masses that were radiographically observed for a period of at least 12 months. Variables examined included patient age, gender, lesion size on presentation, radiographic tumor characteristics, duration of active surveillance linear growth rate, surgical pathology, development of new renal tumors, and stage progression.Results: One hundred nine patients with 124 sporadic enhancing renal tumors were identified undergoing a period of active surveillance of at least 12 months. Median patient age was 73 years (mean 69.8. range 35-87)-72% (78/109) of patients were males. Median duration of active surveillance was 26 months (mean 33.4, range 12-156). Multifocal disease was present in 9% (10/109) of patients on presentation, accounting for 20% (25/124) of all tumors. Tumor size on presentation was a median of 2.0 cm (mean 2.61, range 0.4-12.0). Overall median tumor growth rate was 0.21 cm/y (mean 0.28. range 1.4-2.47). Observed linear growth rates were independent of patient age, gender, tumor size on presentation. multifocality, and radiographic characteristics (solid versus cystic), P > 0.05. Of the patients initiating a period of active surveillance 36% (39/109) eventually underwent definitive therapy. Malignant pathology was present in 90% (35/39) of patients 0 undergoing treatment. In patients continuing active Surveillance [64% (70/109)], 2.9% (2/70) developed de novo renal lesions and 1.4% (1/70) developed metastatic disease.Conclusions: Currently, no clinical predictors Of tumor growth or disease progression have been identified, although. the risk of developing progressive disease over the short term appears low. Clinical and molecular markers of disease progression are needed prior to offering active surveillance to otherwise acceptable surgical candidates. (C) 2008 Elsevier Inc. All rights reserved.