Active surveillance of small renal masses offers short-term oncological efficacy equivalent to radical and partial nephrectomy

作者：Patel Nilay^*; Cranston David; Akhtar M Zeeshan; George Caroline; Jones Andrew; Leiblich Aaron; Protheroe Andrew; Sullivan Mark

来源：BJU International, 2012, 110(9): 1270-1275.

DOI：10.1111/j.1464-410X.2012.11130.x

• active surveillance
• renal carcinoma
• small mass

OBJECTIVE
To compare the oncological outcomes of active surveillance (AS), radical nephrectomy (RN) and partial nephrectomy (PN) in the management of T1a small renal masses (SRMs).
PATIENTS AND METHODS
At present AS is used in the treatment of SRMs in elderly patients with multiple co-morbidities or in those who decline surgery.
We identified all patients with T1a SRMs managed with RN, PN or AS.
Retrospective data were collected from patient case records with survival data and cause of death cross-referenced with the Oxford Cancer Intelligence Unit.
RESULTS
A total of 202 patients with 234 T1a SRMs (solid or Bosniak IV) were identified; 71 patients were managed with AS, 41 with an RN and 90 by PN.
Over a median follow-up of 34 months the mean growth rate on AS was 0.21 cm/year with 53% of SRMs managed with AS showing negative or zero growth.
No statistically significant difference was observed in overall (OS) and cancer-specific (CSS) survival for AS, RN and PN (AS-CSS 98.6%, AS-OS 83%; RN-CSS 92.6%, RN-OS 80.4%; PN-CSS 96.6%, PN-OS 90.0%).
CONCLUSIONS
Active surveillance of SRMs offers oncological efficacy equivalent to surgery in the short/intermediate term.
The results of this study support a multicentre prospective randomized controlled trial designed to compare the oncological efficacy of AS and surgery.

• 出版日期2012-11