Delayed intervention of sporadic renal masses undergoing active surveillance
Delayed intervention of sporadic renal masses undergoing active surveillance
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DOI：
10.1002/cncr.23268
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发表时间：
2008-03-01
期刊：
影响因子：
6.2
通讯作者：
Uzzo, Robert G.
中科院分区：
文献类型：
--
作者：
Crispen, Paul L.;Viterbo, Rosalia;Uzzo, Robert G.
背景资料。及时手术治疗仍然是肾细胞癌(RCC)的标准治疗方法。偶尔，有必要推迟或推迟手术治疗。这份报告的作者评估了积极监测一段时间后的延迟干预是否改变了微创或保留肾单位的治疗计划，增加了分期进展的风险，和/或降低了无复发生存率。方法：作者搜索了他们的机构肾癌数据库，在87个肿瘤中的29个(33%)中确定了小(=12个月)和治疗延迟=24个月(33%)。总体而言，87个肿瘤中有66个(76%)接受了保留肾单位的入路。此外，87个肿瘤中有52个(60%)接受了微创治疗。病理证实87例治疗肿瘤中有73例(84%)为肾细胞癌。54例接受手术切除的肿瘤中，14例(26%)为高危肿瘤，3例(6%)在病理复查中未发现肿瘤。结论：大多数小的、散在的、临床上有局限性的肾肿瘤生长缓慢。这些病变的处理可能会被谨慎地推迟，而不会限制或使现有的治疗方案复杂化，也不会招致疾病进展的高风险。
BACKGROUND. Prompt surgical management remains the standard of care for renal cell carcinoma (RCC). Occasionally, it is necessary to postpone or delay surgical treatment. The authors of this report assessed whether delayed intervention following a period of active surveillance altered minimally invasive or nephron-sparing treatment plans, increased the risk of stage progression, and/or decreased recurrence-free survival rates.METHODS. The authors searched their institutional kidney cancer database to identify small (= 12 months, and treatment was delayed for >= 24 months in 29 of 87 tumors (33%). Overall, 66 of 87 tumors (76%) underwent nephron-sparing approaches. In addition, 52 of 87 tumors (60%) were treated in a minimally invasive fashion. Pathology confirmed RCC in 73 of 87 treated tumors (84%). Fourteen of 54 tumors (26%) that were treated by surgical extirpation were high-risk tumors, and 3 of 54 tumors (6%) were upstaged on pathologic review.CONCLUSIONS. The majority of small, sporadic, clinically localized renal tumors demonstrated slow interval growth. The management of these lesions may be delayed cautiously without limiting or complicating the available treatment options or incurring a high risk of disease progression.