Renal Mass and Localized Renal Cancer: AUA Guideline
Renal Mass and Localized Renal Cancer: AUA Guideline
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DOI：
10.1016/j.juro.2017.04.100
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发表时间：
2017-09-01
影响因子：
6.6
通讯作者：
Pierorazio, Philip M.
中科院分区：
文献类型：
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作者：
Campbell, Steven;Uzzo, Robert G.;Pierorazio, Philip M.
目的：本AUA指南侧重于对临床上疑似癌症的局限性肾肿块的成人患者进行评估/咨询和治疗，包括实性强化肿瘤和Bosniak 3/4复杂囊性病变。材料和方法：系统综述使用了卫生保健研究和质量机构的研究以及作者和咨询方法学家的补充。循证陈述基于证据强度等级A/B/C(分别为强/中/条件性建议)，并以临床原则或专家意见的形式提供补充陈述。结果：自2009年发布先前的局限性肾肿块处理指南以来，取得了很大的进步。目前的指南提供了关于临床局限性肾肿块患者的评估/咨询的最新循证建议，包括肾肿块活检的作用演变。考虑到临床、肿瘤学和功能特征的极大变异性，索引患者不被利用，专家小组主张个性化咨询/管理。综述了治疗方案(部分肾切除/根治性肾切除/热消融/主动监测)，包括关于相对有效性和潜在发病率的最新数据。肿瘤学问题被优先考虑，同时认识到功能结果对大多数局限性肾癌患者的生存非常重要。根据明确的选择标准，建议进行更严格的根治性肾切除术。对于临床上的t1a病变，建议优先行肾部分切除术，同时选择性地使用热消融术，尤其是对肿瘤。
Purpose: This AUA Guideline focuses on evaluation/counseling and management of adult patients with clinically localized renal masses suspicious for cancer, including solid-enhancing tumors and Bosniak 3/4 complex-cystic lesions.Materials and Methods: Systematic review utilized research from the Agency for Healthcare Research and Quality and additional supplementation by the authors and consultant methodologists. Evidence-based statements were based on body of evidence strength Grade A/B/C (Strong/Moderate/Conditional Recommendations, respectively) with additional statements presented as Clinical Principles or Expert Opinions.Results: Great progress has been made since the previous guidelines on management of localized renal masses were released (2009). The current guidelines provide updated, evidence-based recommendations regarding evaluation/counseling of patients with clinically localized renal masses, including the evolving role of renal mass biopsy. Given great variability of clinical, oncologic and functional characteristics, index patients are not utilized and the panel advocates individualized counseling/management. Management options (partial nephrectomy/radical nephrectomy/thermal ablation/active surveillance) are reviewed including recent data about comparative effectiveness and potential morbidities. Oncologic issues are prioritized while recognizing that functional outcomes are of great importance for survivorship for most patients with localized kidney cancer. A more restricted role for radical nephrectomy is recommended following well-defined selection criteria. Priority for partial nephrectomy is recommended for clinical T1a lesions, along with selective use of thermal ablation, particularly for tumors