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Chai JL, Siegmund SE, Hirsch MS, Silverman SG. Low-grade oncocytic tumor: a review of radiologic and clinical features. Abdom Radiol (NY) 2024; 49:1940-1948. [PMID: 38372764 DOI: 10.1007/s00261-023-04167-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 12/09/2023] [Accepted: 12/16/2023] [Indexed: 02/20/2024]
Abstract
PURPOSE The 2022 World Health Organization classification of renal neoplasia expanded the spectrum of oncocytic neoplasms to encompass newly established and emerging entities; one of the latter is the low-grade oncocytic tumor (LOT). This study reports the radiologic appearance and clinical behavior of LOT. METHODS In this IRB-approved, HIPPA-compliant retrospective study, our institution's pathology database was searched for low-grade oncocytic tumors or neoplasms. Patient age, gender, and comorbidities were obtained from a review of electronic medical records, and imaging characteristics of the tumors were assessed through an imaging platform. RESULTS The pathology database search yielded 14 tumors in 14 patients. Four patients were excluded, as radiologic images were not available in three, and one did not fulfill diagnostic criteria after pathology re-review. The resulting cohort consisted of 10 tumors (median diameter 2.3 cm, range 0.7-5.1) in 10 patients (median age 68 years, range 53-91, six women). All tumors presented as a solitary, well-circumscribed, mass with solid components. All enhanced as much or almost as much as adjacent renal parenchyma; all but one enhanced heterogeneously. None had lymphadenopathy, venous invasion, or metastatic disease at presentation or at clinical follow-up (median, 22.2 months, range 3.4-71.6). Among five tumors undergoing active surveillance, mean increase in size was 0.4 cm/year at imaging follow-up (median 16.7 months, range 8.9-25.4). CONCLUSION LOT, a recently described pathologic entity in the kidney, can be considered in the differential diagnosis of an avidly and typically heterogeneously enhancing solid renal mass in an adult patient.
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Affiliation(s)
- Jessie L Chai
- Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA.
| | | | - Michelle S Hirsch
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | - Stuart G Silverman
- Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
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2
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Trovato P, Simonetti I, Morrone A, Fusco R, Setola SV, Giacobbe G, Brunese MC, Pecchi A, Triggiani S, Pellegrino G, Petralia G, Sica G, Petrillo A, Granata V. Scientific Status Quo of Small Renal Lesions: Diagnostic Assessment and Radiomics. J Clin Med 2024; 13:547. [PMID: 38256682 PMCID: PMC10816509 DOI: 10.3390/jcm13020547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 01/05/2024] [Accepted: 01/16/2024] [Indexed: 01/24/2024] Open
Abstract
Background: Small renal masses (SRMs) are defined as contrast-enhanced renal lesions less than or equal to 4 cm in maximal diameter, which can be compatible with stage T1a renal cell carcinomas (RCCs). Currently, 50-61% of all renal tumors are found incidentally. Methods: The characteristics of the lesion influence the choice of the type of management, which include several methods SRM of management, including nephrectomy, partial nephrectomy, ablation, observation, and also stereotactic body radiotherapy. Typical imaging methods available for differentiating benign from malignant renal lesions include ultrasound (US), contrast-enhanced ultrasound (CEUS), computed tomography (CT), and magnetic resonance imaging (MRI). Results: Although ultrasound is the first imaging technique used to detect small renal lesions, it has several limitations. CT is the main and most widely used imaging technique for SRM characterization. The main advantages of MRI compared to CT are the better contrast resolution and tissue characterization, the use of functional imaging sequences, the possibility of performing the examination in patients allergic to iodine-containing contrast medium, and the absence of exposure to ionizing radiation. For a correct evaluation during imaging follow-up, it is necessary to use a reliable method for the assessment of renal lesions, represented by the Bosniak classification system. This classification was initially developed based on contrast-enhanced CT imaging findings, and the 2019 revision proposed the inclusion of MRI features; however, the latest classification has not yet received widespread validation. Conclusions: The use of radiomics in the evaluation of renal masses is an emerging and increasingly central field with several applications such as characterizing renal masses, distinguishing RCC subtypes, monitoring response to targeted therapeutic agents, and prognosis in a metastatic context.
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Affiliation(s)
- Piero Trovato
- Radiology Division, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131 Naples, Italy; (P.T.); (I.S.); (S.V.S.); (A.P.); (V.G.)
| | - Igino Simonetti
- Radiology Division, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131 Naples, Italy; (P.T.); (I.S.); (S.V.S.); (A.P.); (V.G.)
| | - Alessio Morrone
- Division of Radiology, Università degli Studi della Campania Luigi Vanvitelli, 80138 Naples, Italy;
| | - Roberta Fusco
- Medical Oncology Division, Igea SpA, 80013 Naples, Italy
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Via della Signora 2, 20122 Milan, Italy
| | - Sergio Venanzio Setola
- Radiology Division, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131 Naples, Italy; (P.T.); (I.S.); (S.V.S.); (A.P.); (V.G.)
| | - Giuliana Giacobbe
- General and Emergency Radiology Department, “Antonio Cardarelli” Hospital, 80131 Naples, Italy;
| | - Maria Chiara Brunese
- Diagnostic Imaging Section, Department of Medical and Surgical Sciences & Neurosciences, University of Molise, 86100 Campobasso, Italy;
| | - Annarita Pecchi
- Department of Radiology, University of Modena and Reggio Emilia, 41121 Modena, Italy;
| | - Sonia Triggiani
- Postgraduate School of Radiodiagnostics, University of Milan, 20122 Milan, Italy; (S.T.); (G.P.)
| | - Giuseppe Pellegrino
- Postgraduate School of Radiodiagnostics, University of Milan, 20122 Milan, Italy; (S.T.); (G.P.)
| | - Giuseppe Petralia
- Department of Medical Imaging and Radiation Sciences, IEO European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy;
| | - Giacomo Sica
- Radiology Unit, Monaldi Hospital, Azienda Ospedaliera dei Colli, 80131 Naples, Italy;
| | - Antonella Petrillo
- Radiology Division, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131 Naples, Italy; (P.T.); (I.S.); (S.V.S.); (A.P.); (V.G.)
| | - Vincenza Granata
- Radiology Division, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131 Naples, Italy; (P.T.); (I.S.); (S.V.S.); (A.P.); (V.G.)
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3
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Alam R, Yerrapragada A, Wlajnitz T, Watts E, Pallauf M, Enikeev D, Chang P, Wagner AA, McKiernan JM, Pierorazio PM, Allaf ME, Singla N. Evaluation of Growth Rates for Small Renal Masses in Elderly Patients Undergoing Active Surveillance. EUR UROL SUPPL 2023; 50:78-84. [PMID: 37101773 PMCID: PMC10123410 DOI: 10.1016/j.euros.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2023] [Indexed: 03/05/2023] Open
Abstract
Background As the adoption of active surveillance (AS) for small renal masses (SRMs) grows, the number of elderly patients enrolled for a prolonged period of time will increase. However, our understanding of comparative growth rates (GRs) in aging patients with SRMs remains poor. Objective To examine whether particular age cutoffs are associated with an increased GR for patients undergoing AS for SRMs. Design setting and participants We identified all patients with SRMs enrolled in the multi-institutional, prospective Delayed Intervention and Surveillance for Small Renal Masses (DISSRM) registry since 2009 who elected for AS. Outcome measurements and statistical analysis Two definitions of GR were examined: GR from the initial image (GRi) and GR from the prior image (GRp). Image measurements were dichotomized based on patient age at the time of imaging. Multiple age cutoffs were examined: 65, 70, 75, and 80 yr. Mixed-effect linear regression examined the associations between age and GR, with controlling to account for multiple measurements from the same individual. Results and limitations We examined 2542 measurements from 571 patients. The median age at enrollment was 70.9 yr (interquartile range [IQR] 63.2-77.4) with a median tumor diameter of 1.8 cm (IQR 1.4-2.5). As a continuous variable, age was not associated with GRi (-0.0001 cm/yr, 95% confidence interval [CI] -0.007 to 0.007, p = 0.97) or GRp (0.008 cm/yr, 95% CI -0.004 to 0.020, p = 0.17) after adjustment. The only age thresholds associated with an increased GR were 65 yr for GRi and 70 yr for GRp. Limitations include the one-dimensional nature of the measurements used. Conclusions Increased age for patients on AS for SRMs is not associated with increased GRs. Patient summary We examined whether patients undergoing active surveillance (AS) exhibited accelerated growth of their small renal masses (SRMs) after a certain age. No demonstrable change was seen, suggesting that AS is a safe and durable management option for aging patients with SRMs.
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Affiliation(s)
- Ridwan Alam
- Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Anirudh Yerrapragada
- Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Tina Wlajnitz
- Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Emelia Watts
- Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, FL, USA
| | - Maximilian Pallauf
- Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Dmitry Enikeev
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Peter Chang
- Division of Urology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Andrew A. Wagner
- Division of Urology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - James M. McKiernan
- Department of Urology, Columbia University Medical Center, New York, NY, USA
| | - Phillip M. Pierorazio
- Division of Urology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Mohamad E. Allaf
- Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nirmish Singla
- Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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4
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Chai JL, Alencar RO, Hirsch MS, Bhagavatula S, Bay CP, Siegmund S, Chang SL, Silverman SG. Reliability and Management Outcomes Following a Percutaneous Biopsy Diagnosis of Oncocytoma: A 15-year Retrospective Analysis. Radiology 2023; 307:e221156. [PMID: 36692400 DOI: 10.1148/radiol.221156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Background There is uncertainty in the management of renal masses diagnosed as oncocytomas with image-guided percutaneous biopsy. Purpose To assess the reliability of a diagnosis of oncocytoma based on image-guided percutaneous renal mass biopsy and evaluate patient outcomes following different management strategies. Materials and Methods In this retrospective study, image-guided percutaneous biopsy pathology reports from April 2004 to April 2019 were searched for keywords "oncocytoma" and "oncocytic neoplasm" and compared with surgical pathology or repeat biopsy results. Patients with at least 12 months of clinical follow-up and known cause of death were grouped according to management strategies, and disease-specific survival and metastatic renal cell carcinoma (RCC)-free survival were compared. Mass growth rates were calculated with use of a normal linear mixed model. Results The database yielded 160 biopsy reports of 149 renal masses in 139 patients; 149 masses were categorized as oncocytoma (n = 107), likely oncocytoma (n = 12), oncocytic neoplasm (n = 28), and indeterminate with oncocytoma in differential (n = 2). Biopsied masses categorized as oncocytoma or likely oncocytoma were oncocytomas in 16 of 17 masses (94%) based on surgical pathology or repeat biopsy; four of eight masses (50%) categorized as oncocytic neoplasms were low-grade RCCs. Outcome analysis included 121 patients (mean age ± SD, 68 years ± 9.1; 82 men); 80 patients initially underwent active surveillance (11 were later treated), 33 underwent ablation, and eight underwent surgery. Disease-specific survival and metastatic-free survival were 100% after each management strategy (median follow-up, 86.6 months; range, 14.2-207.9 months). Mass growth rate (mean, 1.7 mm per year) showed no evidence of a significant difference among biopsy result categories (P = .37) or initial (P = .84) or final management strategies (P = .11). Conclusion Image-guided percutaneous biopsy diagnosis of renal oncocytoma was reliable. Although some masses diagnosed as oncocytic neoplasms were low-grade renal cell carcinomas (RCCs) at final diagnosis, no patients died of RCC, including those managed with active surveillance. © RSNA, 2023 See also the editorial by Lockhart in this issue.
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Affiliation(s)
- Jessie L Chai
- From the Division of Abdominal Imaging and Intervention, Department of Radiology (J.L.C., R.O.A., S.B., C.P.B., S.G.S.), Department of Pathology (M.S.H., S.S.), Department of Radiology (C.P.B.), and Division of Urology, Department of Surgery (S.L.C.), Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115
| | - Raquel O Alencar
- From the Division of Abdominal Imaging and Intervention, Department of Radiology (J.L.C., R.O.A., S.B., C.P.B., S.G.S.), Department of Pathology (M.S.H., S.S.), Department of Radiology (C.P.B.), and Division of Urology, Department of Surgery (S.L.C.), Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115
| | - Michelle S Hirsch
- From the Division of Abdominal Imaging and Intervention, Department of Radiology (J.L.C., R.O.A., S.B., C.P.B., S.G.S.), Department of Pathology (M.S.H., S.S.), Department of Radiology (C.P.B.), and Division of Urology, Department of Surgery (S.L.C.), Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115
| | - Sharath Bhagavatula
- From the Division of Abdominal Imaging and Intervention, Department of Radiology (J.L.C., R.O.A., S.B., C.P.B., S.G.S.), Department of Pathology (M.S.H., S.S.), Department of Radiology (C.P.B.), and Division of Urology, Department of Surgery (S.L.C.), Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115
| | - Camden P Bay
- From the Division of Abdominal Imaging and Intervention, Department of Radiology (J.L.C., R.O.A., S.B., C.P.B., S.G.S.), Department of Pathology (M.S.H., S.S.), Department of Radiology (C.P.B.), and Division of Urology, Department of Surgery (S.L.C.), Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115
| | - Stephanie Siegmund
- From the Division of Abdominal Imaging and Intervention, Department of Radiology (J.L.C., R.O.A., S.B., C.P.B., S.G.S.), Department of Pathology (M.S.H., S.S.), Department of Radiology (C.P.B.), and Division of Urology, Department of Surgery (S.L.C.), Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115
| | - Steven L Chang
- From the Division of Abdominal Imaging and Intervention, Department of Radiology (J.L.C., R.O.A., S.B., C.P.B., S.G.S.), Department of Pathology (M.S.H., S.S.), Department of Radiology (C.P.B.), and Division of Urology, Department of Surgery (S.L.C.), Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115
| | - Stuart G Silverman
- From the Division of Abdominal Imaging and Intervention, Department of Radiology (J.L.C., R.O.A., S.B., C.P.B., S.G.S.), Department of Pathology (M.S.H., S.S.), Department of Radiology (C.P.B.), and Division of Urology, Department of Surgery (S.L.C.), Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115
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5
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Current perspectives on active surveillance for patients with small renal masses. Asian J Urol 2022; 9:204-205. [PMID: 36035339 PMCID: PMC9399542 DOI: 10.1016/j.ajur.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Indexed: 11/21/2022] Open
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6
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Rodger FE, Brown K, Leung S, Coode‐Bate J, Armitage J, Warren A, Hendry J, Stewart G, Laird A, Oades GM. Real world outcomes of biopsy‐proven oncocytic neoplasm of the kidney managed by surveillance. BJUI COMPASS 2022; 3:291-297. [PMID: 35783590 PMCID: PMC9231677 DOI: 10.1002/bco2.141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 01/01/2022] [Accepted: 01/13/2022] [Indexed: 01/08/2023] Open
Abstract
Objectives To evaluate outcomes of patients diagnosed with oncocytic renal neoplasms on routine renal mass biopsy and to describe the natural history of these tumours when managed with surveillance as opposed to immediate intervention. To report disease‐specific survival. Patients and methods Patients were identified from a retrospective review of pathology databases from three tertiary referral centres that utilise renal mass biopsy in routine clinical practice. All patients with biopsy‐proven oncocytic tumours were included and a retrospective review of online patient records was undertaken. Results There were 184 biopsy‐proven oncocytic renal neoplasms identified in 172 patients. There were two biopsy complications (both pneumothorax, Clavien–Dindo Grade I). Of these lesions, 135 were reported as oncocytomas or oncocytic renal neoplasms that were not further classified and 37 were reported as chromophobe carcinoma (ChRCC). The median age at diagnosis was 70 (33–88). The average tumour diameter at diagnosis was 33 mm. One hundred seven tumours were initially managed with surveillance (including 13 ChRCC) with a minimum follow‐up of 6 months and a median of 39 months (6–144) whereas 49 patients underwent immediate treatment. The mean growth rate across all oncocytic renal neoplasms managed by surveillance was 3 mm/year. There was no statistically significant difference in growth rates between oncocytic renal neoplasms and ChRCC. Thirteen patients with oncocytic renal neoplasms initially managed by surveillance moved on to an active management strategy during follow‐up. The clinical indication given for a change from surveillance was tumour growth in 12 cases and patient choice in 1 case. Where definitive pathology was available, there was 85% concordance with the biopsy. There were no cases of development of metastatic disease or disease‐related morbidity or mortality during the study. Conclusions This multicentre retrospective cohort study supports the hypothesis that selected biopsy‐proven oncocytic renal neoplasms can be safely managed with surveillance in the medium term. Routine renal mass biopsy may reduce surgery for benign or indolent renal tumours and the potential associated morbidity for these patients.
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Affiliation(s)
- Flora E. Rodger
- Department of Urology Queen Elizabeth University Hospital Glasgow UK
| | - Keiran Brown
- Department of Urology Western General Hospital Edinburgh UK
| | - Steve Leung
- Department of Urology The University of Edinburgh, Western General Hospital Edinburgh UK
| | - Jack Coode‐Bate
- Department of Urology University Hospitals Plymouth NHS Trust Plymouth UK
| | - James Armitage
- Department of Urology Addenbrookes Hospital, Cambridge University Hospitals NHS Trust Cambridge UK
| | - Anne Warren
- Department of Pathology Addenbrookes Hospital, Cambridge University Hospitals NHS Trust Cambridge UK
| | - Jane Hendry
- Department of Urology Queen Elizabeth University Hospital Glasgow UK
| | - Grant Stewart
- Department of Urology University of Cambridge Cambridge UK
| | - Alex Laird
- Department of Urology The University of Edinburgh, Western General Hospital Edinburgh UK
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7
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Ellis EE, Messing E. Active Surveillance of Small Renal Masses: A Systematic Review. KIDNEY CANCER 2021. [DOI: 10.3233/kca-210114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: Our goal is to review current literature regarding active surveillance (AS) of small renal masses (SRMs) and identify trends in survival outcomes, factors that predict the need for further intervention, and quality of life (QOL). METHODS: We performed a comprehensive literature search in PubMed and EMBASE and identified 194 articles. A narrative summary was performed in lieu of a meta-analysis due to the heterogeneity of selected studies. RESULTS: Seventeen articles were chosen to be featured in this review. Growth rate (GR) was not an accurate predictor of malignancy, although it was the characteristic most commonly used to trigger delayed intervention (DI). The mean 5-year overall survival (OS) of all studies was 73.6% ±1.7% for AS groups. The combined cancer specific survival (CSS) for AS is 97.1% ±0.6%, compared to 98.6% ±0.4% for the primary intervention (PI) groups, (p = 0.038). CONCLUSIONS: Short and intermediate-term data demonstrate that AS with the option for DI is a management approach whose efficacy (in terms of CSS) approaches that of PI at 5 years, is cost effective, and prevents overtreatment, especially in patients with significant comorbidities.
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Affiliation(s)
| | - Edward Messing
- University of Rochester Medical Center, Rochester, NY, USA
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8
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Dispagna MA, Daneshvar M, Bratslavsky G. Surgical Insights for the Management of Variant Histology in Renal Cell Carcinoma. Int Braz J Urol 2021; 47:935-942. [PMID: 33650834 PMCID: PMC8321463 DOI: 10.1590/s1677-5538.ibju.2020.0778] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 09/03/2020] [Indexed: 11/21/2022] Open
Abstract
Purpose: To review the current literature regarding variant (non-clear) histology of renal cell carcinoma (RCC) and the clinical management of these renal tumors. Material and Methods: A PubMed database search was performed in May 2020 focusing on variant RCC, its diagnosis and associated syndromes, tumor characteristics, and options for management. Results: A broad range of pathological, clinical and diagnostic characteristics amongst non-ccRCC variants were found to have an impact on the overall management of these tumors. The imaging modalities, frequency of surveillance, and timing for intervention were found to be dependent on the type of genetic alterations, type of histology, and tumor growth rates. The timing and type of surgery as well as the systemic therapy are tailored to the specific tumor type and patient. Conclusion: The findings of this review suggest that clinical management should be considered and adjusted for patients with non-ccRCC histological variants based on tumor subtype and genetic alterations.
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Affiliation(s)
| | - Michael Daneshvar
- Department of Urology, SUNY Upstate Medical University, Syracuse, NY, United States
| | - Gennady Bratslavsky
- Department of Urology, SUNY Upstate Medical University, Syracuse, NY, United States
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9
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Neves JB, Varley R, Agnesi S, Withington J, Rodrigues FB, Warren H, Yuminaga Y, Capitanio U, Rode N, Grant L, Tran-Dang MA, El-Sheikh S, Walkden M, Cullen D, Aitchison M, Patki P, Mumtaz F, Barod R, Bex A, Tran MGB. Growth and renal function dynamics of renal oncocytomas in patients on active surveillance. BJU Int 2021; 128:722-727. [PMID: 34046981 DOI: 10.1111/bju.15499] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 04/29/2021] [Accepted: 05/06/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To study the natural history of renal oncocytomas and address indications for intervention by determining how growth is associated with renal function over time, the reasons for surgery and ablation, and disease-specific survival. PATIENTS AND METHODS The study was conducted in a retrospective cohort of consecutive patients with renal oncocytoma on active surveillance reviewed at the Specialist Centre for Kidney Cancer at the Royal Free London NHS Foundation Trust (2012 to 2019). Comparison between groups was performed using Mann-Whitney U-tests and chi-squared tests. A mixed-effects model with a random intercept for patient was used to study the longitudinal association between tumour size and estimated glomerular filtration rate (eGFR). RESULTS Longitudinal data from 98 patients with 101 lesions were analysed. Most patients were men (68.3%) and the median (interquartile range [IQR]) age was 69 (13) years. The median (IQR) follow-up was 29 (26) months. Most lesions were small renal masses, and 24% measured over 4 cm. Over half (64.4%) grew at a median (IQR) rate of 2 (4) mm per year. No association was observed between tumour size and eGFR over time (P = 0.871). Nine lesions (8.9%) were subsequently treated. Two deaths were reported, neither were related to the diagnosis of renal oncocytoma. CONCLUSION Natural history data from the largest active surveillance cohort of renal oncocytomas to date show that renal function does not seem to be negatively impacted by growing oncocytomas, and confirms clinical outcomes are excellent after a median follow-up of over 2 years. Active surveillance should be considered the 'gold standard' management of renal oncocytomas up to 7cm.
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Affiliation(s)
- Joana B Neves
- Division of Surgery and Interventional Science, University College London, London, UK.,Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, London, UK
| | - Rebecca Varley
- Department of General Surgery, Manchester University NHS Foundation Trust, London, UK
| | - Stefano Agnesi
- Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - John Withington
- Urology Unit, Royal Marsden NHS Foundation Trust, London, UK
| | - Filipe B Rodrigues
- UCL Huntington's Disease Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Hannah Warren
- Department of Urology, King's College Hospital NHS Foundation Trust, London, UK
| | - Yuigi Yuminaga
- Department of Urology, Royal Perth Hospital, Perth, WA, Australia
| | - Umberto Capitanio
- Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Nicola Rode
- Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, London, UK
| | - Lee Grant
- Department of Radiology, Royal Free London NHS Foundation Trust, London, UK
| | - My-Anh Tran-Dang
- Department of Histopathology, Royal Free London NHS Foundation Trust, London, UK
| | - Soha El-Sheikh
- Department of Histopathology, Royal Free London NHS Foundation Trust, London, UK
| | - Miles Walkden
- Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, London, UK.,Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK
| | - David Cullen
- Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, London, UK
| | - Michael Aitchison
- Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, London, UK
| | - Prasad Patki
- Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, London, UK
| | - Faiz Mumtaz
- Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, London, UK
| | - Ravi Barod
- Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, London, UK
| | - Axel Bex
- Division of Surgery and Interventional Science, University College London, London, UK.,Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, London, UK
| | - Maxine G B Tran
- Division of Surgery and Interventional Science, University College London, London, UK.,Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, London, UK
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10
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Available active surveillance follow-up protocols for small renal mass: a systematic review. World J Urol 2021; 39:2875-2882. [PMID: 33452911 DOI: 10.1007/s00345-020-03581-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 12/21/2020] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To evaluate follow-up strategies for active surveillance of renal masses and to assess contemporary data. METHODS We performed a comprehensive search of electronic databases (Embase, Medline, and Cochrane). A systematic review of the follow-up protocols was carried out. A total of 20 studies were included. RESULT Our analysis highlights that most of the series used different protocols of follow-up without consistent differences in the outcomes. Most common protocol consisted in imaging and clinical evaluation at 3, 6, and 12 months and yearly thereafter. Median length of follow-up was 42 months (range 1-137). Mean age was 74 years (range 67-83). Of 2243 patients 223 (10%) died during the follow-up and 19 patients died of kidney cancer (0.8%). The growth rate was the most used parameter to evaluate disease progression eventually triggering delayed intervention. Maximal axial diameter was the most common method to evaluate growth rate. CT scan is the most used, probably because it is usually more precise than kidney ultrasound and more accessible than MRI. Performing chest X-ray at every check does not seem to alter the clinical outcome during AS. CONCLUSION The minimal cancer-specific mortality does not seem to correlate with the follow-up scheme. Outside of growth rate and initial size, imaging features to predict outcome of RCC during AS are limited. Active surveillance of SRM is a well-established treatment option. However, standardized follow-up protocols are lacking. Prospective, randomized, trials to evaluate the best follow-up strategies are pending.
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11
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Campi R, Sessa F, Corti F, Carrion DM, Mari A, Amparore D, Mir MC, Fiori C, Papalia R, Kutikov A, Volpe A, Capitanio U, Pierorazio PM, Scarpa RM, Porpiglia F, Minervini A, Serni S, Esperto F. Triggers for delayed intervention in patients with small renal masses undergoing active surveillance: a systematic review. MINERVA UROL NEFROL 2021; 72:389-407. [PMID: 32734748 DOI: 10.23736/s0393-2249.20.03870-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Patients with small renal masses (SRM) can be exposed to overdiagnosis and overtreatment. As such, active surveillance (AS) is recommended by all Guidelines for selected patients. However, it remains underutilized. One key reason is the lack of consensus on the factors prompting delayed intervention (DI). Herein we provide an updated overview of the triggers for DI in patients with SRMs initially undergoing AS. EVIDENCE ACQUISITION A systematic review of the English-language literature was performed according to the PRISMA statement recommendations using the MEDLINE, Cochrane Central Register of Controlled Trials and Web of Science databases. EVIDENCE SYNTHESIS Overall, 10 prospective studies including 1870 patients were included. Median patient age ranged between 64 and 75 years, while median tumor size between 1.7 cm to 2.3 cm. The proportion of cystic SRMs ranged from 0% to 30%. Baseline renal tumor biopsy was performed in 7-45.2% of patients. Among these, malignant histology was found in 28.5%-83.3% of cases. Overall, the median growth rate of SRMs ranged between 0.10 and 0.27 cm/year. The proportion of patients undergoing DI ranged between 7% and 44%, after a median AS period of 12-27 months. The most commonly performed type of DI was surgery. Of resected SRMs, 0% to 30% were benign. The actual triggers for DI were either tumor-related (renal mass growth, stage progression, development of local complications/symptoms) or patient-related (patient preference, improved medical conditions, or qualification for other surgical procedures). At a median follow-up of 21.7 - 57-6 months, the proportion of patients experiencing metastatic disease, cancer-specific and other-cause mortality was 0-3.1%, 0-4% and 0-45.6%, respectively. CONCLUSIONS The available evidence shows that both tumor-related and patient-related factors are ultimate triggers for DI in patients with SRMs undergoing AS. However, the level of evidence is still low and further research is needed to individualize AS strategies according to both tumor biology and patient-related characteristics and values.
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Affiliation(s)
- Riccardo Campi
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy - .,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy - .,European Society of Residents in Urology (ESRU), Arnhem, the Netherlands -
| | - Francesco Sessa
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Francesco Corti
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Diego M Carrion
- European Society of Residents in Urology (ESRU), Arnhem, the Netherlands.,Department of Urology, La Paz University Hospital, Autonomous University of Madrid, Madrid, Spain
| | - Andrea Mari
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Daniele Amparore
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano, Turin, Italy
| | - Maria C Mir
- Department of Urology, Fundacion Instituto Valenciano Oncologia, Valencia, Spain
| | - Cristian Fiori
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano, Turin, Italy
| | - Rocco Papalia
- Department of Urology, Campus Bio-Medico University, Rome, Italy
| | - Alexander Kutikov
- Division of Urology and Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Alessandro Volpe
- Department of Urology, University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | - Umberto Capitanio
- Division of Experimental Oncology, Unit of Urology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Phillip M Pierorazio
- Department of Urology, The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Roberto M Scarpa
- Department of Urology, Campus Bio-Medico University, Rome, Italy
| | - Francesco Porpiglia
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano, Turin, Italy
| | - Andrea Minervini
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Sergio Serni
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Francesco Esperto
- European Society of Residents in Urology (ESRU), Arnhem, the Netherlands.,Department of Urology, Campus Bio-Medico University, Rome, Italy
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Deledalle FX, Doisy L, Daniel L, Garcia S, Lechevallier E, Bastide C, Boissier R. [Evolution of followed renal oncocytomas]. Prog Urol 2020; 30:514-521. [PMID: 32376210 DOI: 10.1016/j.purol.2020.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 06/20/2019] [Accepted: 04/05/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Oncocytomas are primitive kidney tumours, considered benign but their evolution is not fully established. The local progression is generally admitted but few data explain what makes a oncocytoma to grow more or less quickly. The objective of our study is to analyse the evolution of followed renal oncocytomas after histologic confirmation and to identify factors that can influence their growth. MATERIAL AND METHODS This is a retrospective study in two centers (North Hospital and Hospital of the Conception of Marseille). All patients with renal oncocytoma diagnosed with percutaneous biopsy from September 2010 to April 2016 and followed for more than one year were included. Epidemiological, histological, and morphological data were collected at diagnosis, during follow-up and in case of strategy change (intervention). Statistical analysis of factors influencing oncocytomes growth was based on the Pearson correlation test. RESULTS Fifty-three patients were included. The median age for diagnosis was 65 years [39-85]. The sex ratio H/F was 6/5. The median follow-up was 34 months [12-180]. The average diagnosis size was 29 mm [12-90]. Thirteen patients (25%) were treated secondarily, including 70% by conservative treatment. The average growth was 0.25 (±0.23) cm/yr. The patients treated were younger and had a higher growth rate than the untreated (0.48±0.23cm/yr versus 0.18±0.18cm/yr, P<0,001). According to Pearson's analysis, there was a positive linear relationship (R=0.27, P=0.047) between velocity and initial size and a negative linear relationship (ρ=-0.44, P<0.001) between velocity and age at diagnosis. So tumor growth was faster if the patients were young and the tumor voluminous at diagnosis. DISCUSSION Rapid growth often leads to a cessation of surveillance in favour of an intervention strategy. For young patients, conservative treatment (partiel nephrectomy or ablative treatment) in the medium term is likely to be preferred, but for elderly patients or with important comorbidities follow-up is an alternative to an invasive attitude. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- F-X Deledalle
- Service de chirurgie urologique, hôpital de la Conception, AP-HM, 147, boulevard Baille, 13005 Marseille, France; Laboratoire d'anatomopathologie, hôpital de-la-Timone, AP-HM, 264, rue Saint-Pierre, 13005 Marseille, France.
| | - L Doisy
- Service de chirurgie urologique, hôpital de la Conception, AP-HM, 147, boulevard Baille, 13005 Marseille, France; Laboratoire d'anatomopathologie, hôpital de-la-Timone, AP-HM, 264, rue Saint-Pierre, 13005 Marseille, France
| | - L Daniel
- Laboratoire d'anatomopathologie, hôpital de-la-Timone, AP-HM, 264, rue Saint-Pierre, 13005 Marseille, France
| | - S Garcia
- Service de chirurgie urologique, hôpital de la Conception, AP-HM, 147, boulevard Baille, 13005 Marseille, France; Laboratoire d'anatomopathologie, hôpital Nord, AP-HM, chemin des Bourrely, 13015 Marseille, France
| | - E Lechevallier
- Service de chirurgie urologique, hôpital de la Conception, AP-HM, 147, boulevard Baille, 13005 Marseille, France; Laboratoire d'anatomopathologie, hôpital de-la-Timone, AP-HM, 264, rue Saint-Pierre, 13005 Marseille, France
| | - C Bastide
- Service de chirurgie urologique, hôpital de la Conception, AP-HM, 147, boulevard Baille, 13005 Marseille, France; Service de chirurgie urologique, hôpital Nord, AP-HM, chemin des-Bourrely, 13015 Marseille, France
| | - R Boissier
- Laboratoire d'anatomopathologie, hôpital de-la-Timone, AP-HM, 264, rue Saint-Pierre, 13005 Marseille, France
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13
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Martínez Rodríguez C, Tardáguila de la Fuente G, Villanueva Campos A. Current management of small renal masses. RADIOLOGIA 2020. [DOI: 10.1016/j.rxeng.2020.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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14
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Martínez Rodríguez C, Tardáguila de la Fuente G, Villanueva Campos AM. Current management of small renal masses. RADIOLOGIA 2019; 62:167-179. [PMID: 31882171 DOI: 10.1016/j.rx.2019.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 11/18/2019] [Accepted: 11/22/2019] [Indexed: 12/12/2022]
Abstract
One of the consequences of the growing use of diagnostic imaging techniques is the notable growth in the detection of small renal masses presumably corresponding to localized tumors that are potentially curable with surgical treatment. When faced with the finding of a small renal mass, radiologists must determine whether it is benign or malignant, and if it is malignant, what subtype it belong to, and whether it should be managed with surgical treatment, with ablative techniques, or with watchful waiting with active surveillance. Small renal masses are now a clinical entity that require management different from the approaches used for classical renal cell carcinomas. In this scenario, radiologists are key because they are involved in all aspects of the management of these tumors, including in their diagnosis, treatment, and follow-up.
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Pavlakis M, Michaels MG, Tlusty S, Turgeon N, Vece G, Wolfe C, Wood RP, Nalesnik MA. Renal cell carcinoma suspected at time of organ donation 2008-2016: A report of the OPTN ad hoc Disease Transmission Advisory Committee Registry. Clin Transplant 2019; 33:e13597. [PMID: 31104323 DOI: 10.1111/ctr.13597] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 05/04/2019] [Accepted: 05/08/2019] [Indexed: 12/28/2022]
Abstract
All 179 reports to the OPTN of potential renal cell carcinoma (RCC) transmission from 1/1/2008 through 12/31/2016 were reviewed. Cases were divided into those with donor tumor known or suspected at time of transplant (N = 147 donors), and those in which tumor was initially found after transplant (N = 32). We sought to understand the risk of transplanting either the affected kidney, the contralateral kidney or non-renal organs from donors with a suspected/confirmed unilateral RCC. In the case of RCC found prior to transplant, transplantation of 21 kidneys following excision of tumor, 47 contralateral kidneys and 198 non-renal organs was performed. No cases of RCC transmission were documented in this population. An additional six cases of live donor kidney transplantation involving resection of RCC were reported, also without transmission. Six of 9 other recipients in whom the diagnosis of RCC became available after implantation underwent allograft nephrectomy and 3 received tumor resection. No recurrent RCC was documented. Given the low rate of transmission and available treatment options, consideration should be given to judicious use of organs from donors with small solitary RCC.
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Affiliation(s)
- Martha Pavlakis
- Transplant Institute, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | - Susan Tlusty
- United Network for Organ Sharing, Richmond, Virginia
| | - Nicole Turgeon
- Department of Surgery, Emory University, Atlanta, Georgia
| | - Gabriel Vece
- United Network for Organ Sharing, Richmond, Virginia
| | - Cameron Wolfe
- Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina
| | | | - Michael A Nalesnik
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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16
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Touma NJ, Hosier GW, Di Lena MA, Leslie RJ, Ho L, Menard A, Siemens DR. Growth rates and outcomes of observed large renal masses. Can Urol Assoc J 2018; 13:276-281. [PMID: 30526807 DOI: 10.5489/cuaj.5545] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
INTRODUCTION The natural history of small renal masses has been well defined, leading to the recommendation of active surveillance in some patients with limited life expectancy. However, this information is less clear for large renal masses (LRM), leading to ambiguity for management in the older, comorbid patient. The objective of this study was to define the natural history, including the growth rate and metastatic risk, of LRM in order to better counsel patients regarding active surveillance. METHODS This was a retrospective review of patients with solid renal masses >4 cm that had repeated imaging identified from an institutional imaging database. Patient comorbidities and outcomes were obtained through retrospective chart analysis. Outcomes assessed included tumour growth and metastatic rates, as well as cancer-specific (CSS) and overall survival (OS) usimg Kaplan-Meier methodology. RESULTS We identified 69 patients between 2005 and 2016 who met the inclusion criteria. Mean age at study entry was 75.5 years; mean tumour maximal dimension at study entry was 5.6 cm. CSS was 83% and OS 63% for patients presenting without metastasis, with a mean followup of 57.5 months. The mean growth rate of those that developed metastasis during followup (n=15) was 0.98 cm/year (95% confidence interval [CI] 0.33-1.63) as compared to those that did not develop metastasis (n=46), with a growth rate of 0.67 cm/year (95% CI 0.34-1) (non-significant). Seven patients had evidence of metastasis at the baseline imaging of their LRM and had subsequent growth rate of 1.47 cm/year (95% CI 0.37-2.57) (non-significant) CONCLUSIONS: Compared to small renal masses, LRM are associated with higher metastasis rates and lower CSS and more rapid growth rates. Selection criteria for recommending observation of LRM in older, comorbid patients should be more conservative than for small renal masses.
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Affiliation(s)
- Naji J Touma
- Department of Urology, Queen's University Kingston, ON, Canada
| | | | | | - Robert J Leslie
- Department of Urology, Queen's University Kingston, ON, Canada
| | - Louisa Ho
- Department of Urology, Queen's University Kingston, ON, Canada
| | - Alexandre Menard
- Department of Radiology, Queen's University Kingston, ON, Canada
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Bensalah K, Albiges L, Bernhard JC, Bigot P, Bodin T, Boissier R, Correas JM, Gimel P, Hetet JF, Long JA, Nouhaud FX, Ouzaïd I, Rioux-Leclercq N, Méjean A. RETRACTED: Recommandations françaises du Comité de Cancérologie de l’AFU – Actualisation 2018–2020 : prise en charge du cancer du reinFrench ccAFU guidelines – Update 2018–2020: Management of kidney cancer. Prog Urol 2018; 28:S3-S31. [PMID: 30473002 DOI: 10.1016/j.purol.2018.09.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 09/15/2018] [Indexed: 12/15/2022]
Abstract
This article has been retracted: please see Elsevier Policy on Article Withdrawal (http://www.elsevier.com/locate/withdrawalpolicy).
Cet article est retiré de la publication à la demande des auteurs car ils ont apporté des modifications significatives sur des points scientifiques après la publication de la première version des recommandations.
Le nouvel article est disponible à cette adresse: DOI:10.1016/j.purol.2019.01.004.
C’est cette nouvelle version qui doit être utilisée pour citer l’article.
This article has been retracted at the request of the authors, as it is not based on the definitive version of the text because some scientific data has been corrected since the first issue was published.
The replacement has been published at the DOI:10.1016/j.purol.2019.01.004.
That newer version of the text should be used when citing the article.
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Affiliation(s)
- K Bensalah
- Comité de cancérologie de l'Association française d'urologie, groupe rein, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Service d'urologie, hôpital Pontchaillou, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35033, Rennes cedex, France.
| | - L Albiges
- Comité de cancérologie de l'Association française d'urologie, groupe rein, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Département d'oncologie génito-urinaire, Gustave-Roussy, 94805, Villejuif cedex, France
| | - J-C Bernhard
- Comité de cancérologie de l'Association française d'urologie, groupe rein, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Service d'urologie et transplantation rénale, CHU de Bordeaux, place Amélie-Raba-Léon, 33076, Bordeaux, France
| | - P Bigot
- Comité de cancérologie de l'Association française d'urologie, groupe rein, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Service d'urologie, CHU d'Angers, 4, rue Larrey, 49000, Angers, France
| | - T Bodin
- Comité de cancérologie de l'Association française d'urologie, groupe rein, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Centre d'urologie Prado-Louvain, 188, rue du Rouet, 13008, Marseille, France
| | - R Boissier
- Comité de cancérologie de l'Association française d'urologie, groupe rein, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Service d'urologie et transplantation rénale, CHU Conception, 147, boulevard Baille, 13005, Marseille, France
| | - J-M Correas
- Comité de cancérologie de l'Association française d'urologie, groupe rein, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Service d'imagerie médicale (radiologie), hôpital universitaire Necker-Enfants-malades, 149, rue de Sèvres, 75015, Paris, France
| | - P Gimel
- Comité de cancérologie de l'Association française d'urologie, groupe rein, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Centre d'urologie, site Médipôle, 5, avenue Ambroise-Croizat, 66330, Cabestany, France
| | - J-F Hetet
- Comité de cancérologie de l'Association française d'urologie, groupe rein, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Service de chirurgie urologique, clinique Jules-Verne, 2-4, route de Paris, 44314, Nantes, France
| | - J-A Long
- Comité de cancérologie de l'Association française d'urologie, groupe rein, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Service de chirurgie urologique et de la transplantation rénale, hôpital Michallon, CHU Grenoble, boulevard de la Chantourne, 38700, La Tronche, France
| | - F-X Nouhaud
- Comité de cancérologie de l'Association française d'urologie, groupe rein, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Service d'urologie, CHU de Rouen, 1, rue de Germont, 76000, Rouen, France
| | - I Ouzaïd
- Comité de cancérologie de l'Association française d'urologie, groupe rein, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Clinique urologique, hôpital Bichat-Claude-Bernard, 46, rue Henri-Huchard, 75018, Paris, France
| | - N Rioux-Leclercq
- Comité de cancérologie de l'Association française d'urologie, groupe rein, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Service d'anatomie et cytologie pathologiques, CHU Pontchaillou, 2, rue Henri-le-Guilloux, 35033, Rennes cedex 9, France
| | - A Méjean
- Comité de cancérologie de l'Association française d'urologie, groupe rein, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Service d'urologie, hôpital européen Georges-Pompidou, université Paris Descartes, AP-HP, 75015, Paris, France
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Mir MC, Capitanio U, Bertolo R, Ouzaid I, Salagierski M, Kriegmair M, Volpe A, Jewett MAS, Kutikov A, Pierorazio PM. Role of Active Surveillance for Localized Small Renal Masses. Eur Urol Oncol 2018; 1:177-187. [PMID: 31102618 DOI: 10.1016/j.euo.2018.05.001] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 04/16/2018] [Accepted: 05/02/2018] [Indexed: 11/29/2022]
Abstract
CONTEXT Stage migration of organ-confined renal masses is occurring as a result of incidental diagnosis, especially in the elderly. Active surveillance (AS) is gaining clinical traction as a treatment alternative to surgery and focal therapy. OBJECTIVE To assess contemporary data and evaluate AS risk trade-offs in the treatment of organ-confined kidney cancer. EVIDENCE ACQUISITION A comprehensive search of the Embase, Medline and Cochrane databases was carried out. A systematic review of the role of AS for organ-confined renal masses was performed. A total of 28 studies were included in the systematic review. EVIDENCE SYNTHESIS The median linear tumor growth rate for clinically localized renal masses (CLRMs) was 0.37cm/yr (interquartile range 0.15-0.7), with 0.22cm/yr in the cT1a subgroup and 0.45cm/yr in the cT1b--2 subgroup. The metastatic progression rate was 1-6% and was similar for cT1a (1-6%) and cT1b (0-5%); other-cause mortality for patients with CLRMs was 0-45% (1-25% for cT1a vs 11-13% for cT1b-2); cancer-specific mortality ranged between 0% and 18%. According to the 2011 Oxford scale, AS as a treatment option for CLRMs remains supported by level 3 evidence. CONCLUSIONS Although no randomized clinical data are available, current data support oncologic safety for AS in the management of CLRMs, particularly for small renal masses and among elderly and/or comorbid patients. PATIENT SUMMARY In this review we looked at the outcomes for patients with small kidney masses managed with surveillance. We found that surveillance is a safe initial option for tumors of less than 2cm, especially in elderly and sick patients.
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Affiliation(s)
- Maria Carmen Mir
- Department of Urology, Fundación Instituto Valenciano de Oncologia, Valencia, Spain.
| | - Umberto Capitanio
- Department of Urology, San Raffaele Scientific Institute, Milan, Italy; Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS San Raffaele Hospital, Milan, Italy
| | - Riccardo Bertolo
- Division of Urology, Department of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Turin, Italy
| | - Idir Ouzaid
- Department of Urology, Bichat Hospital, APHP, Paris Diderot University, Paris, France
| | | | | | - Alessandro Volpe
- Department of Urology, University of Novara, Maggiore della Carità Hospital, Novara, Italy
| | - Michael A S Jewett
- Departments of Surgery (Urology) and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada
| | - Alexander Kutikov
- Division of Urologic Oncology, Fox Chase Cancer Center, Temple Health System, Philadelphia, PA, USA
| | - Phillip M Pierorazio
- James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Tricard T, Tsoumakidou G, Lindner V, Garnon J, Albrand G, Cathelineau X, Gangi A, Lang H. Thérapies ablatives dans le cancer du rein : indications. Prog Urol 2017; 27:926-951. [DOI: 10.1016/j.purol.2017.07.245] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 07/22/2017] [Indexed: 12/19/2022]
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20
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Jang A, Patel HD, Riffon M, Gorin MA, Semerjian A, Johnson MH, Allaf ME, Pierorazio PM. Multiple growth periods predict unfavourable pathology in patients with small renal masses. BJU Int 2017; 121:732-736. [PMID: 28990323 DOI: 10.1111/bju.14051] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To use the number of positive growth periods as a characterization of the growth of small renal masses in order to determine potential predictors of malignancy. PATIENTS AND METHODS Patients who underwent axial imaging at multiple time points prior to surgical resection for a small renal mass were queried. Patients were categorized based on their pathological tumour grade and stage: favourable (benign, chromophobe and low-grade pT1-2 renal cell carcinoma [RCC]) vs unfavourable (high-grade of any stage and low-grade pT3-4 RCC). A positive growth period was counted each time the difference in greatest tumour diameters between two images was positive. The Cochran-Armitage trend test and Somers' D association were used to determine if the number of positive growth periods was correlated with unfavourable pathology. RESULTS Of the 124 patients, 86 (69.4%) had favourable pathology and 38 (30.6%) had unfavourable pathology. Those who had favourable pathology were younger than those who had unfavourable pathology: median (interquartile range [IQR]) 61.0 (52.2-66.0) vs 68.5 (61.5-77.0); P < 0.001. The overall growth rate was higher in the unfavourable group, but was not statistically significant: mean (sd) 0.7 (1.7) vs 1.6 (2.8) cm/year; P = 0.07. There was a significant trend difference in the number of positive growth periods between favourability groups (P = 0.02). An association between increased number of positive growth periods and unfavourable pathology was observed: 0.15 (95% confidence interval 0.02, 0.29). The ratios of favourable to unfavourable pathology were 1.8, 1.0, 0.66, 0.59 and 0 as the number of positive growth periods increased from 0 to 4, respectively. CONCLUSION While overall growth rate was not predictive of pathology favourability, there was a positive association between the number of positive growth periods and unfavourable pathology. The number of positive growth periods may be a potential parameter for malignant potential in patients undergoing active surveillance for small renal masses.
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Affiliation(s)
- Alex Jang
- Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Hiten D Patel
- Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mark Riffon
- Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael A Gorin
- Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alice Semerjian
- Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael H Johnson
- Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mohamad E Allaf
- Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Phillip M Pierorazio
- Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Abstract
OBJECTIVE Birt-Hogg-Dubé (BHD) syndrome is an autosomal dominant inherited syndrome involving multiple organs. In young patients, renal neoplasms that are multiple, bilateral, or both, such as oncocytomas, chromophobe renal cell carcinoma (RCC), hybrid chromophobe RCC-oncocytomas, clear cell RCC, and papillary RCC, can suggest BHD syndrome. Extrarenal findings, including dermal lesions, pulmonary cysts, and spontaneous pneumothoraces, also aid in diagnosis. CONCLUSION Radiologists may be one of the first medical specialists to suggest the diagnosis of BHD syndrome. Knowledge of pathogenesis and management, including the importance of the types of renal neoplasms in a given patient, is needed to properly recognize this rare condition.
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Galia M, Albano D, Bruno A, Agrusa A, Romano G, Di Buono G, Agnello F, Salvaggio G, La Grutta L, Midiri M, Lagalla R. Imaging features of solid renal masses. Br J Radiol 2017; 90:20170077. [PMID: 28590813 DOI: 10.1259/bjr.20170077] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The widespread use of abdominal imaging techniques has increased the detection of solid renal masses over the past years. Imaging plays a crucial role in the management and surveillance and in determining which lesions need treatment. The "classical angiomyolipoma" is the only benign solid renal mass that can be characterized with confidence by imaging through the detection of a fat-containing lesion without calcifications. There is a large overlap of imaging features between benign and malignant renal masses that often makes difficult a correct characterization of these lesions. In this review, we discuss the imaging features of the main solid renal masses that may suggest a likely benign diagnosis.
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Affiliation(s)
- Massimo Galia
- 1 Department of Radiology, DIBIMED, University of Palermo, Palermo, Italy
| | - Domenico Albano
- 1 Department of Radiology, DIBIMED, University of Palermo, Palermo, Italy
| | - Alberto Bruno
- 1 Department of Radiology, DIBIMED, University of Palermo, Palermo, Italy
| | - Antonino Agrusa
- 2 Department of General Surgery and Emergency, University of Palermo, Palermo, Italy
| | - Giorgio Romano
- 2 Department of General Surgery and Emergency, University of Palermo, Palermo, Italy
| | - Giuseppe Di Buono
- 2 Department of General Surgery and Emergency, University of Palermo, Palermo, Italy
| | - Francesco Agnello
- 1 Department of Radiology, DIBIMED, University of Palermo, Palermo, Italy
| | - Giuseppe Salvaggio
- 1 Department of Radiology, DIBIMED, University of Palermo, Palermo, Italy
| | - Ludovico La Grutta
- 1 Department of Radiology, DIBIMED, University of Palermo, Palermo, Italy
| | - Massimo Midiri
- 1 Department of Radiology, DIBIMED, University of Palermo, Palermo, Italy
| | - Roberto Lagalla
- 1 Department of Radiology, DIBIMED, University of Palermo, Palermo, Italy
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23
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Delayed Intervention of Small Renal Masses on Active Surveillance. J Kidney Cancer VHL 2017; 4:24-30. [PMID: 28725541 PMCID: PMC5515897 DOI: 10.15586/jkcvhl.2017.75] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Accepted: 05/10/2017] [Indexed: 01/17/2023] Open
Abstract
Although surgical excision is the standard of therapy for small renal masses (SRMs), there is a growing recognition of active surveillance as an option in select patients who are poor surgical candidates or who have shorter life expectancy. A number of patients on expectant management, however, subsequently advance to definitive therapy. In this study, we systematically reviewed the literature and performed a pooled analysis of active surveillance series to evaluate the rate and indications for definitive treatment after initiating a period of active surveillance. Fourteen clinical series (1245 patients; 1364 lesions) met our selection criteria. Mean lesion size at presentation was 2.30 ± 0.40 cm with a mean follow-up of 33.6 ± 16.9 months. Collectively, 34.0% of patients underwent delayed intervention, which ranged in individual series from 3.6% to 70.3%. Of patients undergoing delayed intervention, the average time on active surveillance prior to definitive treatment was 27.8 ± 10.6 months. A pooled analysis revealed that 41.0% of patients underwent therapy secondary to tumor growth rate and 51.9% secondary to patient or physician preference in the absence of clinical progression. Overall, 1.1% of all patients progressed to metastatic disease during the average follow-up period. Thus, active surveillance may be an appropriate option for carefully selected patients with SRMs. However, delayed treatment is pursued in a significant percentage of patients within 3 years. Prospective registries and clinical trials with standardized indications for delayed intervention are needed to establish true rates of disease progressions and recommendations for delayed intervention.
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Ristau BT, Kutikov A, Uzzo RG, Smaldone MC. Active Surveillance for Small Renal Masses: When Less is More. Eur Urol Focus 2017; 2:660-668. [PMID: 28723504 DOI: 10.1016/j.euf.2017.04.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 04/05/2017] [Indexed: 12/29/2022]
Abstract
CONTEXT A marked increase in incidentally detected small renal masses (SRMs) has occurred over the past decade. Active surveillance (AS) has emerged as an initial management option for these patients. OBJECTIVE (1) To determine selection criteria, assess appropriate imaging modalities and surveillance frequencies, and define triggers for delayed intervention (DI) for patients on AS. (2) To describe oncologic outcomes for patients on AS protocols. EVIDENCE ACQUISITION The PubMed database was queried for English language articles using the keywords "surveillance" and "renal mass" or "renal cell carcinoma" or "kidney cancer." The level of evidence, sample size, study design, and relevance to the review were considered as inclusion criteria. EVIDENCE SYNTHESIS A total of 69 manuscripts were included in the review. Selection criteria at initial evaluation for patients interested in AS include patient-related factors (eg, age, baseline renal function, other comorbidities), tumor-related factors (size, complexity, history of growth, possible renal mass biopsy), and patient preferences (illness uncertainty, quality of life). Cross-sectional imaging is the preferred initial imaging modality. Surveillance imaging should be performed at frequent intervals (3-4 mo) up front; intervals can be reduced over time if favorable growth kinetics are demonstrated. Delayed intervention (DI) should be considered for rapid tumor growth (eg,>0.5cm/yr), an increase in maximum tumor diameter >3-4cm, malignant renal mass biopsy results, development of symptoms, or patient preferences. Oncologic outcomes in well-controlled studies demonstrate a metastatic rate of 1-2%. Most patients who undergo DI remain eligible for nephron-sparing approaches; oncologic outcomes are not compromised by DI strategies. CONCLUSIONS A period of initial AS is safe for most patients with SRMs. Management decisions should focus on a thorough assessment of risk-benefit trade-offs, judiciously integrating patient-related factors, tumor-related factors, and patient preferences. PATIENT SUMMARY A period of initial active surveillance for kidney masses of ≤4cm in diameter is safe in most patients. Frequent imaging and follow-up are necessary to determine if the tumor grows. If delayed intervention becomes necessary, cancer outcomes are not compromised by the initial choice of active surveillance when patients adhere to close follow-up regimens.
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Affiliation(s)
- Benjamin T Ristau
- Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA.
| | - Alexander Kutikov
- Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Robert G Uzzo
- Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Marc C Smaldone
- Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
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Active Surveillance for the Small Renal Mass: Growth Kinetics and Oncologic Outcomes. Urol Clin North Am 2017; 44:213-222. [PMID: 28411913 DOI: 10.1016/j.ucl.2016.12.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Active surveillance for small renal masses (SRMs) is an accepted management strategy for patients with prohibitive surgical risk. Emerging prospectively collected data support the concept that a period of initial active surveillance in an adherent patient population with well-defined criteria for delayed intervention is safe. This article summarizes the literature describing growth kinetics of SRMs managed initially with observation and oncologic outcomes for patients managed with active surveillance. Existing clinical tools to determine and contextualize competing risks to mortality are explored. Finally, current prospective clinical trials with defined eligibility criteria, surveillance schema, and triggers for delayed intervention are highlighted.
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26
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Abstract
Renal cell carcinoma is the tenth most common malignancy in the USA, with upwards of 61,000 new cases and resulting in more than 14,000 deaths annually. Although partial nephrectomy remains the standard treatment, image-guided nephron-sparing ablative techniques including cryoablation, radiofrequency ablation, and microwave ablation have emerged as treatment options in certain patient populations. Ablative therapies have high technical successes, low tumor recurrence rates, and preserve renal parenchymal volume. The purpose of this article is to provide an update on ablation therapies for small renal masses.
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27
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Liu S, Lee S, Rashid P, Bangash H, Hamid A, Lau J, Cohen R. Active surveillance is suitable for intermediate term follow-up of renal oncocytoma diagnosed by percutaneous core biopsy. BJU Int 2016; 118 Suppl 3:30-34. [PMID: 27457972 DOI: 10.1111/bju.13538] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Shuo Liu
- Royal Perth Hospital; Perth WA Australia
- Port Macquarie Base Hospital; Port Macquarie NSW Australia
| | - Stephen Lee
- Uropath Pty Ltd; West Leederville WA Australia
- Faculty of Medicine and Dentistry; School of Pathology and Laboratory Medicine; University of Western Australia; Crawley WA Australia
| | - Prem Rashid
- Port Macquarie Base Hospital; Port Macquarie NSW Australia
- Faculty of Medicine; Rural Clinical School; University of New South Wales; Sydney NSW Australia
| | - Haider Bangash
- Royal Perth Hospital; Perth WA Australia
- Fiona Stanley Hospital; Perth WA Australia
| | - Akhlil Hamid
- Royal Perth Hospital; Perth WA Australia
- Fiona Stanley Hospital; Perth WA Australia
| | - Jason Lau
- Uropath Pty Ltd; West Leederville WA Australia
| | - Ronald Cohen
- Uropath Pty Ltd; West Leederville WA Australia
- Faculty of Medicine and Dentistry; School of Pathology and Laboratory Medicine; University of Western Australia; Crawley WA Australia
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28
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Elstob A, Gonsalves M, Patel U. Diagnostic modalities. Int J Surg 2016; 36:504-512. [PMID: 27321380 DOI: 10.1016/j.ijsu.2016.06.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 05/23/2016] [Accepted: 06/04/2016] [Indexed: 01/17/2023]
Abstract
The incidental detection of small renal masses on imaging undertaken to evaluate unrelated symptoms or conditions is an increasingly common occurrence. Accurate imaging characterisation is fundamental to determining optimum patient management. The goals of imaging small renal masses include determining whether a lesion is solid or cystic, if there are signs of biological aggressiveness and whether the lesion is likely benign or malignant. The current imaging practices and the evidence supporting the use of different imaging modalities for the characterisation of small renal masses are discussed. CT remains the primary imaging modality and is able to classify most masses into surgical or non-surgical lesions. MRI and contrast enhanced ultrasound are most often employed to problem solve in lesions deemed indeterminate on contrast enhanced CT or for patients in which CECT is contraindicated. Percutaneous biopsy should be considered in lesions that remain indeterminate after initial imaging investigations. Given the central role of imaging in the management of small renal masses, all multidisciplinary team members involved in renal cancer care should have an understanding of the performance of the different imaging modalities.
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Affiliation(s)
- Alison Elstob
- Radiology Department, St George's University Hospitals NHS Foundation Trust, Blackshaw Road, London, SW17 0QT, UK.
| | - Michael Gonsalves
- Radiology Department, St George's University Hospitals NHS Foundation Trust, Blackshaw Road, London, SW17 0QT, UK
| | - Uday Patel
- Radiology Department, St George's University Hospitals NHS Foundation Trust, Blackshaw Road, London, SW17 0QT, UK
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29
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Zhang L, Yao L, Li X, Jewett MA, He Z, Zhou L. Natural history of renal cell carcinoma: An immunohistochemical analysis of growth rate in patients with delayed treatment. J Formos Med Assoc 2016; 115:463-9. [DOI: 10.1016/j.jfma.2015.05.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 05/13/2015] [Accepted: 05/13/2015] [Indexed: 01/12/2023] Open
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Abstract
Objective: To review the natural history and growth kinetics of small renal masses (SRMs). Data Sources: The literature concerning natural history and growth kinetics of SRMs was collected from PubMed published from 1990 to 2014. Study Selection: We included all the relevant articles on the active surveillance (AS) or delayed treatment for SRMs in English, with no limitation of study design. Results: SRMs under AS have a slow growth potential in general. The mean linear growth rate is 0.33 cm/year, the mean volumetric growth rate is 9.48 cm3/year. The rate of metastasis during AS is below 2%. Some factors are associated with the growth rate of SRMs, including tumor grade, histological subtype, initial tumor size, age, radiographic characteristics, and molecular markers. No definite predictor of growth rate of SRMs is defined at present. SRMs with high tumor grade and the subtype of clear cell renal cell carcinoma may have aggressive growth potential. Conclusions: AS is a reasonable choice for elderly patients with SRMs, who are at high risk from surgery. Progression during observation is the biggest concern while performing AS. There is no definite predictor of progression for SRMs under AS. Percutaneous renal biopsy providing immunohistological and genic biomarkers may improve the understanding of natural history of SRMs.
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Affiliation(s)
| | - Xue-Song Li
- Department of Urology, Peking University First Hospital, Beijing 100034, China
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32
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Ponsky L, Lo SS, Zhang Y, Schluchter M, Liu Y, Patel R, Abouassaly R, Welford S, Gulani V, Haaga JR, Machtay M, Ellis RJ. Phase I dose-escalation study of stereotactic body radiotherapy (SBRT) for poor surgical candidates with localized renal cell carcinoma. Radiother Oncol 2015; 117:183-7. [DOI: 10.1016/j.radonc.2015.08.030] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 08/26/2015] [Accepted: 08/29/2015] [Indexed: 12/01/2022]
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Richard PO, Jewett MAS, Bhatt JR, Evans AJ, Timilsina N, Finelli A. Active Surveillance for Renal Neoplasms with Oncocytic Features is Safe. J Urol 2015; 195:581-6. [PMID: 26388501 DOI: 10.1016/j.juro.2015.09.067] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2015] [Indexed: 01/18/2023]
Abstract
PURPOSE Oncocytomas are benign tumors often diagnosed incidentally on imaging. Small case series have suggested that the growth kinetics of oncocytomas are similar to those of malignant renal tumors. Biopsy material may be insufficient to exclude a diagnosis of chromophobe renal cell carcinoma. We evaluated and compared the growth rates of oncocytoma and chromophobe renal cell carcinoma to improve our understanding of their natural history. MATERIALS AND METHODS This was a single center, retrospective study of patients diagnosed with lesions suggestive of oncocytoma or chromophobe renal cell carcinoma between 2003 and 2014. The growth rates were estimated using a mixed effect linear model. Patient and lesion characteristics were tested using a similar model for association with growth rate. RESULTS Of the 95 lesions (oncocytoma 81, chromophobe renal cell carcinoma 14) included in the analysis 98% were diagnosed on biopsy. The annual growth rate was 0.14 cm and 0.38 cm for oncocytoma (median followup 34 months) and chromophobe renal cell carcinoma (median followup 25 months), respectively (p=0.5). Baseline lesion size was significantly associated with growth (p <0.001). The majority of oncocytomas (74%) and chromophobe renal cell carcinomas (67%) followed up to the 3-year mark had grown. Of these, 8 underwent surgery (6 in the chromophobe renal cell carcinoma group). The initial diagnosis was confirmed in all. Overall 5 patients died, all of nonrenal related causes. CONCLUSIONS Although the majority of oncocytic renal neoplasms will grow with time, surveillance appears to remain safe. Patients opting for this strategy should be made aware that a diagnosis of oncocytoma following biopsy is associated with some degree of uncertainty due to the difficulty of differentiating them from other oncocytic renal neoplasms.
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Affiliation(s)
- Patrick O Richard
- Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, Ontario, Canada
| | - Michael A S Jewett
- Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, Ontario, Canada
| | - Jaimin R Bhatt
- Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, Ontario, Canada
| | - Andrew J Evans
- Department of Laboratory Medicine and Pathobiology, Toronto General Hospital, University Health Network and the University of Toronto, Toronto, Ontario, Canada
| | - Narhari Timilsina
- Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, Ontario, Canada
| | - Antonio Finelli
- Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, Ontario, Canada.
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Growth Pattern of Clear Cell Renal Cell Carcinoma in Patients with Delayed Surgical Intervention: Fast Growth Rate Correlates with High Grade and May Result in Poor Prognosis. BIOMED RESEARCH INTERNATIONAL 2015; 2015:598134. [PMID: 26421295 PMCID: PMC4573233 DOI: 10.1155/2015/598134] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Accepted: 03/08/2015] [Indexed: 11/18/2022]
Abstract
Objectives. Previous studies revealed an unclear correlation between the growth rate of renal cell carcinoma (RCC) and tumor grade and did not focus on certain histological subtype. This report investigated the correlation between the growth rate and tumor grade in clear cell RCC (ccRCC). Methods. We reviewed 60 patients with 61 ccRCC confirmed by delayed surgeries after at least 12 months of active surveillance. The linear growth rate (LGR), volumetric growth rate (VGR), and volume doubling time (VDT) were calculated, and their correlations with clinicopathologic characteristics were analyzed. Results. The mean LGR, VGR, and VDT were 0.86 (range 0–4.74) cm/year, 20.96 (range 0.31–211.93) cm3/year, and 667 (range 33–3321) days, respectively. ccRCCs with high grade had greater LGR (P < 0.001) and VGR (P = 0.001) and lower VDT (P = 0.017) than ccRCCs with low grade. Grade (OR = 5.185, P = 0.004) was the only independent risk factor of LGR >0.5 cm/year, and grade (OR = 3.006, P = 0.046) and initial size (OR = 0.392, P = 0.004) were independent risk factors of VDT <1 year. Five patients developed metastasis after surgery with LGR >0.5 cm/yr altogether; of them, four had cancer-related death by the last follow-up. Conclusions. Fast growth rate of ccRCC is significantly correlated with high tumor grade and may result in poor prognosis, especially for those with LGR >0.5 cm/yr.
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Conti A, Santoni M, Sotte V, Burattini L, Scarpelli M, Cheng L, Lopez-Beltran A, Montironi R, Cascinu S, Muzzonigro G, Lund L. Small renal masses in the era of personalized medicine: Tumor heterogeneity, growth kinetics, and risk of metastasis. Urol Oncol 2015; 33:303-9. [DOI: 10.1016/j.urolonc.2015.04.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 03/07/2015] [Accepted: 04/06/2015] [Indexed: 12/26/2022]
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36
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Role of MRI in indeterminate renal mass: diagnostic accuracy and impact on clinical decision making. Int Urol Nephrol 2015; 47:585-93. [DOI: 10.1007/s11255-015-0928-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 01/30/2015] [Indexed: 01/28/2023]
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Abstract
Image-guided ablation (IGA) techniques have evolved considerably over the past 20 years and are increasingly used to definitively treat small primary cancers of the liver and kidney. IGA is recommended by most guidelines as the best therapeutic choice for patients with early stage hepatocellular carcinoma (HCC)-defined as either a single tumour smaller than 5 cm or up to three nodules smaller than 3 cm-when surgical options are precluded, and has potential as first-line therapy, in lieu of surgery, for patients with very early stage tumours smaller than 2 cm. With regard to renal cell carcinoma, despite the absence of any randomized trial comparing the outcomes of IGA with those of standard partial nephrectomy, a growing amount of data demonstrate robust oncological outcomes for this minimally invasive approach and testify to its potential as a standard-of-care treatment. Herein, we review the various ablation techniques, the supporting evidence, and clinical application of IGA in the treatment of primary liver and kidney cancers.
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Affiliation(s)
- David J Breen
- Department of Radiology, University Hospitals of Southampton, Tremona Road, Southampton, Hampshire SO16 6YD, UK
| | - Riccardo Lencioni
- Department of Liver Transplantation, Hepatology and Infectious Diseases, Division of Diagnostic Imaging and Intervention, Pisa University Hospital and School of Medicine, Building No. 29, 2nd Floor, Via Paradisa 2, IT-56124 Pisa, Italy
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Ishigami K, Jones AR, Dahmoush L, Leite LV, Pakalniskis MG, Barloon TJ. Imaging spectrum of renal oncocytomas: a pictorial review with pathologic correlation. Insights Imaging 2014; 6:53-64. [PMID: 25504153 PMCID: PMC4330236 DOI: 10.1007/s13244-014-0373-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Revised: 11/15/2014] [Accepted: 11/21/2014] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES The purpose of this pictorial review is to present the imaging spectrum of renal oncocytomas with radiological-pathological correlation. CONCLUSION The differences in tumour cellularity (high cellularity or low cellularity with abundant stroma) and haemorrhagic/cystic change contribute to a wide spectrum of imaging findings of renal oncocytomas. Imaging findings substantially overlap those of common subtypes of clear cell and non-clear cell renal cell carcinomas. Multifocal renal oncocytomas are not rare, and making the diagnosis of oncocytoma with concomitant renal cell carcinoma is difficult. In addition, renal oncocytomas that demonstrate interval growth or develop in the setting of end-stage renal disease may be mistaken for malignancy. TEACHING POINTS • High cellular components demonstrate avid arterial enhancement and subsequent washout. • Low cellular components demonstrate gradual subsequent enhancement owing to abundant stroma. • Cystic and hemorrhagic changes may account for lesion heterogeneity in the delayed phase. • Multifocal oncocytomas and oncocytomas coexisting with renal cell carcinoma are not rare. • Renal oncocytomas may demonstrate interval growth.
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Affiliation(s)
- Kousei Ishigami
- Department of Radiology, University of Iowa Hospitals and Clinics, 3885 JPP, 200 Hawkins Drive, Iowa City, IA, 52242, USA,
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Mehrazin R, Smaldone MC, Kutikov A, Li T, Tomaszewski JJ, Canter DJ, Viterbo R, Greenberg RE, Chen DYT, Uzzo RG. Growth kinetics and short-term outcomes of cT1b and cT2 renal masses under active surveillance. J Urol 2014; 192:659-64. [PMID: 24641909 DOI: 10.1016/j.juro.2014.03.038] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2014] [Indexed: 01/08/2023]
Abstract
PURPOSE Compared to T1a lesions the natural history of untreated renal masses larger than 4 cm is poorly understood. We assessed the growth kinetics and outcomes of cT1b/T2 cortical renal tumors managed by an initial period of active surveillance. We compared these cases to those treated with definitive delayed intervention. MATERIALS AND METHODS We reviewed our institutional, prospectively maintained renal tumor database to identify enhancing solid and cystic masses managed expectantly. Included in analysis were clinically localized tumors greater than 4.0 cm (T1b or greater) that were radiographically followed for more than 6 months. Tumor size at presentation, annual linear tumor growth rate, Charlson comorbidity index, followup and clinical outcomes were compared in patients who remained on active surveillance and those who underwent delayed surgical intervention. RESULTS We identified 72 tumors 4 cm or greater in diameter in a total of 68 patients. Active surveillance was the only treatment in 45 patients (66%) while 23 (34%) progressed to intervention. Median tumor size at presentation was 4.9 cm and the mean linear growth rate was 0.44 cm per year. Of the masses 14.7% demonstrated no growth with time. Comparing patients treated exclusively with active surveillance and those who progressed to definitive intervention revealed no difference in median tumor size at presentation (4.9 vs 4.6 cm, p = 0.79) or the median Charlson comorbidity index (3 vs 2, p = 0.6) but significant differences were seen in median age at presentation (77 vs 60 years, p = 0.0002) and the mean linear growth rate (0.37 vs 0.73 cm per year, p = 0.02). After adjustment younger patients (OR 0.91, 95% CI 0.86-0.97) and tumors with a faster linear growth rate (OR 9.1, 95% CI 1.7-47.8) were more likely to be treated with delayed surgical intervention. At a mean ± SD 38.9 ± 24.0 months of followup (median 32, range 6 to 105) 9 patients (13%) had died of another cause and none had progressed to metastatic disease. CONCLUSIONS Localized cT1b or larger renal masses show growth rates comparable to those of small tumors managed expectantly with a low rate of progression to metastatic disease at short-term followup. An initial period of active surveillance to determine tumor growth kinetics is a reasonable option in select patients with significant competing risks and limited life expectancy.
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Affiliation(s)
- Reza Mehrazin
- Division of Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center-Temple University Health System, Philadelphia, Pennsylvania.
| | - Marc C Smaldone
- Division of Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center-Temple University Health System, Philadelphia, Pennsylvania
| | - Alexander Kutikov
- Division of Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center-Temple University Health System, Philadelphia, Pennsylvania
| | - Tianyu Li
- Division of Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center-Temple University Health System, Philadelphia, Pennsylvania
| | - Jeffrey J Tomaszewski
- Division of Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center-Temple University Health System, Philadelphia, Pennsylvania
| | - Daniel J Canter
- Division of Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center-Temple University Health System, Philadelphia, Pennsylvania
| | - Rosalia Viterbo
- Division of Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center-Temple University Health System, Philadelphia, Pennsylvania
| | - Richard E Greenberg
- Division of Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center-Temple University Health System, Philadelphia, Pennsylvania
| | - David Y T Chen
- Division of Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center-Temple University Health System, Philadelphia, Pennsylvania
| | - Robert G Uzzo
- Division of Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center-Temple University Health System, Philadelphia, Pennsylvania
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Audenet F, Audouin M, Drouin SJ, Comperat E, Mozer P, Chartier-Kastler E, Méjean A, Cussenot O, Shariat SF, Rouprêt M. Charlson score as a single pertinent criterion to select candidates for active surveillance among patients with small renal masses. World J Urol 2013; 32:513-8. [DOI: 10.1007/s00345-013-1131-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Accepted: 07/09/2013] [Indexed: 10/26/2022] Open
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Abstract
PURPOSE OF REVIEW Management options for small renal masses (SRMs) include excision, ablation, and active surveillance. Increasing interest in active surveillance, particularly for tumors of limited oncologic potential, in patients with other significant health concerns continues to rise, but precise protocols are still lacking. RECENT FINDINGS A review of 18 retrospective series of patients undergoing active surveillance for 957 SRMs indicates that the majority grew during observation (mean 0.32 cm/year), but only 1.4% metastasized during 32 months of follow-up (median). One published prospective series of 209 SRMs reported average growth of 0.13 cm/year and only 1% metastasized. Maximal tumor diameter (or volume) at presentation is a predictor of growth rate, high-grade disease, and likelihood of metastasis. SRMs less than 3 cm are very unlikely to metastasize and deferring treatment has not been associated with increased failure to cure. SUMMARY Active surveillance is a reasonable initial strategy in most patients with SRMs, particularly those with limited life-expectancy and increased perioperative risk. Intervention should be considered for growth to greater than 3-4 cm or by greater than 0.4-0.5 cm/year while on active surveillance.
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Comparison of CT-Based Methodologies for Detection of Growth of Solid Renal Masses on Active Surveillance. AJR Am J Roentgenol 2012; 199:373-8. [DOI: 10.2214/ajr.11.7735] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Kurup AN, Thompson RH, Leibovich BC, Harmsen WS, Sebo TJ, Callstrom MR, Kawashima A, Atwell TD. Renal oncocytoma growth rates before intervention. BJU Int 2012; 110:1444-8. [DOI: 10.1111/j.1464-410x.2012.011136.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Li XS, Yao L, Gong K, Yu W, He Q, Zhou LQ, He ZS. Growth pattern of renal cell carcinoma (RCC) in patients with delayed surgical intervention. J Cancer Res Clin Oncol 2011; 138:269-74. [PMID: 22105897 DOI: 10.1007/s00432-011-1083-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2011] [Accepted: 11/01/2011] [Indexed: 01/28/2023]
Abstract
PURPOSE Few studies have evaluated the growth pattern of renal cell carcinoma (RCC) in patients with delayed treatment. This report investigated the growth rate and stage progression of incidentally discovered RCC following a long period of active surveillance. METHODS Thirty-two patients who did not receive immediate surgical treatment for renal solid masses that later proved to be RCC were reviewed retrospectively. Annual tumor growth rates were calculated according to changes in the maximal diameter on CT or MRI. Clinical and pathological characteristics associated with tumor growth rate and stage progression were analyzed. RESULTS The median tumor size grow from 2.14 (range, 0.30-6.70) cm to 4.33 (range, 1.40-8.80) cm after a median 46.0 months observation period. The average tumor growth rate was 0.80 (range, 0.16-3.80) cm/year. Clear cell carcinoma (0.86 cm/year) tended to grow faster than papillary cell carcinoma (0.28 cm/year) (P = 0.066). The mean growth rate of grade 2 tumors (0.88 cm/year) was faster than that of grade 1 tumors (0.36 cm/year) (P = 0.041). Thirteen tumors (40.6%) were upstaged at a median 48 months after initial presentation. Cox regression analysis revealed initial tumor size as the only risk factor for upstaging (P = 0.018). No local and systemic recurrences were noted in our cohort after the intervention at a median of 47 (range, 6-248) months of follow-up. CONCLUSIONS RCCs were found to be slow growing in a group of untreated renal cell carcinoma patients. However, some tumors progressed in stage under observation. The growth rate of RCC tended to correlate with histologic grade and histologic subtype.
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Affiliation(s)
- Xue-Song Li
- Department of Urology, First Hospital of Peking University, Institute of Urology, Peking University, National Urological Cancer Center, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China
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Smaldone MC, Uzzo RG. Active surveillance: a potential strategy for select patients with small renal masses. Future Oncol 2011; 7:1133-47. [DOI: 10.2217/fon.11.97] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Increased abdominal imaging has led to the significant incidental detection of clinically localized renal masses. While the gold standard remains surgical excision, mortality rates from kidney cancer remain relatively unchanged implying that a proportion of small renal masses may be indolent tumors that do not require surgical intervention. As a result, active surveillance has emerged as an alternative management strategy in select patients with significant competing risks. Although the contemporary literature characterizing the natural history of untreated small renal masses is limited, recent data demonstrate that many incidental renal masses demonstrate slow growth kinetics with a low rate of progression to metastatic disease over an intermediate time period. Prospective trials are necessary to define entry and intervention criteria for active surveillance protocols.
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Affiliation(s)
- Marc C Smaldone
- Department of Surgery, Division of Urologic Oncology, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA 19111, USA
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Kawaguchi S, Fernandes KA, Finelli A, Robinette M, Fleshner N, Jewett MA. Most Renal Oncocytomas Appear to Grow: Observations of Tumor Kinetics With Active Surveillance. J Urol 2011; 186:1218-22. [DOI: 10.1016/j.juro.2011.05.080] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2011] [Indexed: 11/16/2022]
Affiliation(s)
- Sarah Kawaguchi
- Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | - Kimberly A. Fernandes
- Department of Biostatistics, Princess Margaret Hospital and University Health Network, Toronto, Ontario, Canada
| | - Antonio Finelli
- Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | - Michael Robinette
- Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | - Neil Fleshner
- Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | - Michael A.S. Jewett
- Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
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Chi A, Shirodkar SP, Escudero DO, Ekwenna OO, Yates TJ, Ayyathurai R, Garcia-Roig M, Gahan JC, Manoharan M, Bird VG, Lokeshwar VB. Molecular characterization of kidney cancer: association of hyaluronic acid family with histological subtypes and metastasis. Cancer 2011; 118:2394-402. [PMID: 21887686 DOI: 10.1002/cncr.26520] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2011] [Revised: 07/12/2011] [Accepted: 07/15/2011] [Indexed: 01/21/2023]
Abstract
BACKGROUND Molecular profiling of renal cell carcinomas (RCCs) may improve the distinction between oncocytoma and malignant RCC subtypes and aid in early detection of metastasis. The hyaluronic acid (HA) family includes HA synthases (HAS1, HAS2, HAS3), hyaluronidases (HYAL-1, HYAL-2, HYAL-3, HYAL-4, PH20, HYAL-P1), and HA receptors (CD44s, CD44v, RHAMM). HA family members promote tumor growth and metastasis. The authors evaluated the expression of HA family members in kidney specimens. METHODS By using quantitative polymerase chain reaction, mRNA levels of 12 HA family members were measured in tumor specimens obtained from 86 consecutive patients undergoing nephrectomy; 80 of them also provided normal specimens. Mean and median follow-up were 15.2 ± 8.8 and 13.8 months. RCC specimens included clear cell RCC: 65; papillary: 10; chromophobe: 5; oncocytoma: 6; metastasis positive: 17. RESULTS Median HAS1, CD44s, and RHAMM transcript levels were elevated 3- to 25-fold in clear cell RCC and papillary and chromophobe tumors when compared with normal tissues. HYAL-4, CD44s, and RHAMM levels were elevated 4- to 12-fold in clear cell RCC and papillary tumors when compared with oncocytomas; only HYAL-4 levels distinguished between chromophobe and oncocytoma (P = .009). CD44s and RHAMM levels were significantly higher in tumors <4 cm (510 ± 611 and 19.6 ± 20.8, respectively) when compared with oncocytoma (46.4 ± 20 and 3.8 ± 2.5; P ≤ .006). In univariate and multivariate analyses, CD44s (P < .0001), RHAMM (P < .0001), stage, tumor size, and/or renal vein involvement were significantly associated with metastasis. The combined CD44s + RHAMM marker had 82% sensitivity and 86% specificity to predict metastasis. CONCLUSIONS CD44s and RHAMM levels distinguish between oncocytoma and RCC subtypes regardless of tumor size and are potential predictors of RCC metastasis.
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Affiliation(s)
- Andrew Chi
- Department of Urology, University of Miami School of Medicine, Miami, Florida 33101, USA
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Pallwein-Prettner L, Flöry D, Rotter CR, Pogner K, Syré G, Fellner C, Frauscher F, Aigner F, Krause FS, Fellner F. Assessment and characterisation of common renal masses with CT and MRI. Insights Imaging 2011; 2:543-556. [PMID: 22347975 PMCID: PMC3259318 DOI: 10.1007/s13244-011-0116-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2010] [Revised: 05/12/2011] [Accepted: 06/28/2011] [Indexed: 01/19/2023] Open
Abstract
Objective Owing to the widespread use of abdominal imaging studies the detection rate of solid renal masses has increased, and an accurate characterisation of imaging features of renal masses has become more essential for case management. Method and results MR imaging (MRI) and computed tomography (CT) are frequently used modalities for detection and differentiation of renal masses. This article gives a review of imaging characteristics of benign and malignant renal masses, discussing their appearance in CT and MR imaging. Advanced MR techniques like diffusion-weighted imaging and apparent diffusion coefficient (ADC) mapping, which have shown promising results in the differentiation between benign and malignant renal lesions, will be introduced. Conclusion MRI and CT are useful in the characterisation and estimation of the prognosis for renal masses.
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Affiliation(s)
- Leo Pallwein-Prettner
- Department of Radiology, General Hospital Linz, Krankenhausstrasse 9, 4020 Linz, Austria
| | - Daniel Flöry
- Department of Radiology, General Hospital Linz, Krankenhausstrasse 9, 4020 Linz, Austria
| | | | - Kurt Pogner
- Department of Urology, General Hospital Linz, Linz, Austria
| | - Gerhard Syré
- Department of Pathology, General Hospital Linz, Linz, Austria
| | - Claudia Fellner
- Institute of Radiology, University Medical Center Regensburg, Regensburg, Germany
| | | | - Friedrich Aigner
- Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
| | | | - Franz Fellner
- Department of Radiology, General Hospital Linz, Krankenhausstrasse 9, 4020 Linz, Austria
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Smaldone MC, Kutikov A, Egleston BL, Canter DJ, Viterbo R, Chen DYT, Jewett MA, Greenberg RE, Uzzo RG. Small renal masses progressing to metastases under active surveillance: a systematic review and pooled analysis. Cancer 2011; 118:997-1006. [PMID: 21766302 DOI: 10.1002/cncr.26369] [Citation(s) in RCA: 281] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2011] [Revised: 05/30/2011] [Accepted: 06/01/2011] [Indexed: 12/21/2022]
Abstract
BACKGROUND The authors systematically reviewed the literature and conducted a pooled analysis of studies on small renal masses who underwent active surveillance to identify the risk progression and the characteristics associated with metastases. METHODS A search of the MEDLINE database was performed to identify all clinical series that reported the surveillance of localized renal masses. For studies that reported individual-level data, clinical and radiographic characteristics of tumors without progression were compared with the characteristics of tumors that progressed to metastases. RESULTS Eighteen series (880 patients, 936 masses) met screening criteria; and, among these, 18 patients were identified who had tumors that progressed to metastasis (mean, 40.2 months). Six studies (259 patients, 284 masses) provided individual-level data for pooled analysis. At a mean (± standard deviation) follow-up of 33.5 ± 22.6 months, the mean initial greatest tumor dimension was 2.3 ± 1.3 cm, and mean linear growth rate was 0.31 ± 0.38 cm per year. Sixty-five masses (23%) exhibited zero net growth under surveillance, and none of those masses progressed to metastasis. A pooled analysis revealed increased age (age 75.1 ± 9.1 years vs 66.6 ± 12.3 years; P = .03), an initial greatest tumor dimension (4.1 ± 2.1 cm vs 2.3 ± 1.3 cm; P < .0001), initial estimated tumor volume (66.3 ± 100.0 cm(3) vs 15.1 ± 60.3 cm(3) ; p = .0001), linear growth rate of (0.8 ± 0.65 cm per year vs 0.3 ± 0.4 cm per year; P = .0001), and a volumetric growth rate of 27.1 ± 24.9 cm(3) per year (vs 6.2 ± 27.5 cm(3) per year; P < .0001) in the progression cohort. CONCLUSIONS A substantial proportion of small renal masses remained radiographically static after an initial period of active surveillance. Progression to metastases occurred in a small percentage of patients and generally was a late event. The current results indicated that, in patients who have competing health risks, radiographic surveillance may be an acceptable initial approach, and delayed intervention may be reserved for patients who have tumors that exhibit significant linear or volumetric growth.
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Affiliation(s)
- Marc C Smaldone
- Division of Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania 19111, USA
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