Natural History, Growth Kinetics, and Outcomes of Untreated Clinically Localized Renal Tumors Under Active Surveillance
Natural History, Growth Kinetics, and Outcomes of Untreated Clinically Localized Renal Tumors Under Active Surveillance
复制标题
DOI：
10.1002/cncr.24338
复制
发表时间：
2009-07-01
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：未经治疗的实体器官恶性肿瘤的生长动力学尚未确定。对不适合或不愿意接受干预的患者的肾肿瘤进行放射线主动监测（AS），为量化未经治疗的局部肿瘤的自然史提供了机会。作者报告了监测期间肾肿瘤的放射线生长动力学。方法：作者确定了肾脏肿块增强的患者，并对其进行了至少 12 个月的放射学观察。回顾临床和病理记录以确定肿瘤生长动力学和临床结果。肿瘤生长动力学以绝对和相对线性和体积生长来表达。结果：作者在 154 名 AS 患者中发现了 172 个肾肿瘤。就诊时的中位肿瘤直径和体积分别为 2.0 cm（平均值，2.5；范围，0.4-12.0）和 4.18 cm(3)（平均值，20.0；范围，0.033-904）。中位随访时间为 24 个月（平均 31 个月；范围 12-156）。注意到肿瘤大小与生长比例之间存在显着关联，较小的肿瘤比较大的肿瘤生长得更快。 39%（173 例中的 68 例）肿瘤接受了延迟干预，84%（68 例中的 57 例）为病理恶性。 1.3% 的患者（154 名患者中有 2 名）进展为转移性疾病。结论：作者证明了肿瘤体积与随后生长之间的关联，较小的肿瘤比较大的肿瘤表现出明显更快的体积生长，这与 Gompertzian 动力学一致。局部肾肿瘤的监测与中期疾病进展率较低有关，并表明某些患者可能存在过度治疗偏差。癌症 2009；115：2844-52。 (C) 2009 年美国癌症协会。
BACKGROUND: The growth kinetics of untreated solid organ malignancies are not defined. Radiographic active surveillance (AS) of renal tumors in patients unfit or unwilling to undergo intervention provides an opportunity to quantify the natural history of untreated localized tumors. The authors report the radiographic growth kinetics of renal neoplasms during a period of surveillance. METHODS: The authors identified patients with enhancing renal masses who were radiographically observed for at least 12 months. Clinical and pathological records were reviewed to determine tumor growth kinetics and clinical outcomes. Tumor growth kinetics were expressed in terms of absolute and relative linear and volumetric growth. RESULTS: The authors identified 172 renal tumors in 154 patients under AS. Median tumor diameter and volume on presentation were 2.0 cm (mean, 2.5; range, 0.4-12.0) and 4.18 cm(3) (mean, 20.0; range, 0.033-904). Median duration of follow-up was 24 months (mean, 31; range, 12-156). A significant association between presenting tumor size and proportional growth was noted, with smaller tumors growing faster than larger tumors. Thirty-nine percent (68 of 173) of tumors underwent delayed intervention, and 84% (57 of 68) were pathologically malignant. Progression to metastatic disease was noted in 1.3% (2 of 154) of patients. CONCLUSIONS: The authors demonstrated the association between a tumor's volume and subsequent growth, with smaller tumors exhibiting significantly faster volumetric growth than larger tumors, consistent with Gompertzian kinetics. Surveillance of localized renal tumors is associated with a low rate of disease progression in the intermediate term, and suggests potential overtreatment biases in select patients. Cancer 2009;115:2844-52. (C) 2009 American Cancer Society.