Follow-up for Clinically Localized Renal Neoplasms: AUA Guideline
Follow-up for Clinically Localized Renal Neoplasms: AUA Guideline
复制标题
DOI：
10.1016/j.juro.2013.04.121
复制
发表时间：
2013-08-01
影响因子：
6.6
通讯作者：
Chang, Sam S.
中科院分区：
文献类型：
--
作者：
Donat, Sherri M.;Diaz, Mireya;Chang, Sam S.
目的：本指南的目的是提供一个临床框架，为后续的临床局限性肾肿瘤进行积极的监测，或以下明确的治疗。材料和方法：一项系统性文献综述确定了1999年1月至2011年期间在英文文献中发表的与专家组指定的与肾肿瘤及其随访相关的关键问题相关的文章（影像学、肾功能、标记物、活检、预后）。研究设计包括临床试验（随机或不），观察性研究（队列，病例对照，病例系列）和系统reviews.Results：指南声明提供了指导，正在进行的肾功能评价，肾活检的有用性，时间/类型的放射成像和制定未来的研究计划。缺乏研究排除了肿瘤分期以外的风险分层;因此，出于术后监测指南的目的，基于病理肿瘤分期，将局限性肾癌患者分为低风险和中风险至高风险的疾病复发分层。对接受积极监测和肾肿瘤确定性治疗的患者的评价应包括体格检查、肾功能，应根据复发风险、合并症和治疗后遗症监测进行调整。专家意见确定了一个明智的监测/监督过程，随着手术/消融治疗的发展，肾活检准确性的提高和收集更多的长期随访数据，监测/监督的强度可能会发生变化。随着进一步研究的完成，还需要对仔细的后续行动的有益影响进行严格的评价。
Purpose: The purpose of this guideline is to provide a clinical framework for follow-up of clinically localized renal neoplasms undergoing active surveillance, or following definitive therapy.Materials and Methods: A systematic literature review identified published articles in the English literature between January 1999 and 2011 relevant to key questions specified by the Panel related to kidney neoplasms and their follow-up (imaging, renal function, markers, biopsy, prognosis). Study designs consisting of clinical trials (randomized or not), observational studies (cohort, case-control, case series) and systematic reviews were included.Results: Guideline statements provided guidance for ongoing evaluation of renal function, usefulness of renal biopsy, timing/type of radiographic imaging and formulation of future research initiatives. A lack of studies precluded risk stratification beyond tumor staging; therefore, for the purposes of postoperative surveillance guidelines, patients with localized renal cancers were grouped into strata of low-and moderate-to high-risk for disease recurrence based on pathological tumor stage.Conclusions: Evaluation for patients on active surveillance and following definitive therapy for renal neoplasms should include physical examination, renal function, serum studies and imaging and should be tailored according to recurrence risk, comorbidities and monitoring for treatment sequelae. Expert opinion determined a judicious course of monitoring/surveillance that may change in intensity as surgical/ablative therapies evolve, renal biopsy accuracy improves and more long-term follow-up data are collected. The beneficial impact of careful follow-up will also need critical evaluation as further study is completed.