Pathological and Clinical Outcomes in a Large Surveillance and Intervention Cohort of Radiographically Cystic Renal Masses
Pathological and Clinical Outcomes in a Large Surveillance and Intervention Cohort of Radiographically Cystic Renal Masses
复制标题
放射学囊性肾肿块大型监测和干预队列的病理和临床结果
DOI：
10.1097/ju.0000000000003158
复制
发表时间：
2023
期刊：
影响因子：
--
通讯作者：
A. Kutikov
中科院分区：
文献类型：
--
作者：
Randall A. Lee;R. Uzzo;J. Anaokar;Ashanth Thomas;Shuanzeng Wei;B. Ristau;Andrew G. McIntosh;Matthew S. Lee;David Y. T. Chen;R. Greenberg;R. Viterbo;M. Smaldone;A. Correa;J. Schober;K. Ginsburg;L. Bukavina;D. Magee;Nicole Uzzo;Phyllis Parkansky;K. Ruth;A. Kutikov
目的：我们评估了一大群接受主动监测或干预的放射学囊性肾肿块患者的肿瘤风险。材料和方法：对 2000 年至 2020 年间通过主动监测或干预进行管理的 4,340 个肾脏病变的单一机构数据库进行查询，以了解放射学囊性肾肿块。评估了放射学肿瘤特征和高级病理学的关联。结果：我们在 367 名患者中发现了 387 个经影像学证实的囊性病变。其中，247 例被切除（n=240）或消融（n=7；n=247，203 例立即干预，44 例延迟干预）。病理学上，23% (n=56) 表现出高级病理学。仅 18% (n=33) 的所有病变和 7% (n=4) 的高级别病变通过病理学明确描述了囊性特征。在干预队列中，非裔美国人种族、男性和波斯尼亚克评分与高级病理学相关（P < .05）。在主动监测 (n=184) 中，Bosniak IV 病灶表现出比 IIF 和 III 病灶更快的生长速度（2.7 vs 0.6 和 0.5 mm/y，P ≤ .001）；然而，生长率与高级病理学无关（P = .5）。比较 5 年干预与主动监测时，未发现癌症特异性生存率存在差异（99% vs 100%，P = .2）。立即干预与延迟干预之间没有观察到复发差异（P > .9）。结论：肾脏病变的影像学和病理学上的“囊性”指定之间存在脱节。超过 80% 的放射学波斯尼亚克囊性病变在病理报告中未被描述为“囊性”。超过五分之一的切除囊性肾病灶表现出高度疾病。尽管有这一发现，对于大多数放射学囊性肾肿块来说，明智管理的主动监测±延迟干预是一种安全有效的管理选择。
Purpose: We evaluated oncologic risks in a large cohort of patients with radiographic cystic renal masses who underwent active surveillance or intervention. Materials and Methods: A single-institutional database of 4,340 kidney lesions managed with either active surveillance or intervention between 2000-2020 was queried for radiographically cystic renal masses. Association of radiographic tumor characteristics and high-grade pathology was evaluated. Results: We identified 387 radiographically confirmed cystic lesions in 367 patients. Of these, 247 were resected (n=240) or ablated (n=7; n=247, 203 immediate vs 44 delayed intervention). Pathologically, 23% (n=56) demonstrated high-grade pathology. Cystic features were explicitly described by pathology in only 18% (n=33) of all lesions and in 7% (n=4) of high-grade lesions. Of the intervention cohort, African American race, male gender, and Bosniak score were associated with high-grade pathology (P < .05). On active surveillance (n=184), Bosniak IV lesions demonstrated faster growth rates than IIF and III lesions (2.7 vs 0.6 and 0.5 mm/y, P ≤ .001); however, growth rates were not associated with high-grade pathology (P = .5). No difference in cancer-specific survival was identified when comparing intervention vs active surveillance at 5 years (99% vs 100%, P = .2). No difference in recurrence was observed between immediate intervention vs delayed intervention (P > .9). Conclusions: A disconnect between “cystic” designation on imaging and pathology exists for renal lesions. Over 80% of radiographic Bosniak cystic lesions are not described as “cystic” on pathology reports. More than 1 in 5 resected cystic renal lesions demonstrated high-grade disease. Despite this finding, judiciously managed active surveillance ± delayed intervention is a safe and effective management option for most radiographic cystic renal masses.