دورية أكاديمية
Pathological and Clinical Outcomes in a Large Surveillance and Intervention Cohort of Radiographically Cystic Renal Masses.
| العنوان: | Pathological and Clinical Outcomes in a Large Surveillance and Intervention Cohort of Radiographically Cystic Renal Masses. |
|---|---|
| المؤلفون: | Lee RA; Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania., Uzzo RG; Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania., Anaokar J; Department of Radiology, Fox Chase Cancer Center, Philadelphia, Pennsylvania., Thomas A; Department of Radiology, Fox Chase Cancer Center, Philadelphia, Pennsylvania., Wei S; Department of Pathology, Fox Chase Cancer Center, Philadelphia, Pennsylvania., Ristau BT; Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania., McIntosh A; Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania., Lee M; Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania., Chen DYT; Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania., Greenberg RE; Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania., Viterbo R; Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania., Smaldone MC; Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania., Correa A; Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania., Schober J; Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania., Ginsburg K; Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania., Bukavina L; Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania., Magee D; Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania., Uzzo N; Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania., Parkansky P; Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania., Ruth K; Department of Biostatistics, Fox Chase Cancer Center, Philadelphia, Pennsylvania., Kutikov A; Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania. |
| المصدر: | The Journal of urology [J Urol] 2023 Apr; Vol. 209 (4), pp. 686-693. Date of Electronic Publication: 2023 Jan 11. |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Wolters Kluwer Country of Publication: United States NLM ID: 0376374 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1527-3792 (Electronic) Linking ISSN: 00225347 NLM ISO Abbreviation: J Urol Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: 2019- : [Philadelphia, PA] : Wolters Kluwer Original Publication: Baltimore : Lippincott Williams & Wilkins |
| مواضيع طبية MeSH: | Kidney Neoplasms*/diagnostic imaging , Kidney Neoplasms*/surgery , Kidney Neoplasms*/pathology , Kidney Diseases, Cystic*/diagnostic imaging , Kidney Diseases, Cystic*/surgery , Carcinoma, Renal Cell*/pathology, Humans ; Male ; Tomography, X-Ray Computed/methods ; Kidney/pathology ; Retrospective Studies |
| مستخلص: | Purpose: We evaluated oncologic risks in a large cohort of patients with radiographic cystic renal masses who underwent active surveillance or intervention. Materials and Methods: A single-institutional database of 4,340 kidney lesions managed with either active surveillance or intervention between 2000-2020 was queried for radiographically cystic renal masses. Association of radiographic tumor characteristics and high-grade pathology was evaluated. Results: We identified 387 radiographically confirmed cystic lesions in 367 patients. Of these, 247 were resected (n=240) or ablated (n=7; n=247, 203 immediate vs 44 delayed intervention). Pathologically, 23% (n=56) demonstrated high-grade pathology. Cystic features were explicitly described by pathology in only 18% (n=33) of all lesions and in 7% (n=4) of high-grade lesions. Of the intervention cohort, African American race, male gender, and Bosniak score were associated with high-grade pathology ( P < .05). On active surveillance (n=184), Bosniak IV lesions demonstrated faster growth rates than IIF and III lesions (2.7 vs 0.6 and 0.5 mm/y, P ≤ .001); however, growth rates were not associated with high-grade pathology ( P = .5). No difference in cancer-specific survival was identified when comparing intervention vs active surveillance at 5 years (99% vs 100%, P = .2). No difference in recurrence was observed between immediate intervention vs delayed intervention ( P > .9). Conclusions: A disconnect between "cystic" designation on imaging and pathology exists for renal lesions. Over 80% of radiographic Bosniak cystic lesions are not described as "cystic" on pathology reports. More than 1 in 5 resected cystic renal lesions demonstrated high-grade disease. Despite this finding, judiciously managed active surveillance ± delayed intervention is a safe and effective management option for most radiographic cystic renal masses. |
| التعليقات: | Comment in: J Urol. 2023 Sep;210(3):408-409. (PMID: 37378561) |
| فهرسة مساهمة: | Keywords: carcinoma; kidney diseases, cystic; renal cell; treatment outcome |
| تواريخ الأحداث: | Date Created: 20230111 Date Completed: 20230310 Latest Revision: 20230810 |
| رمز التحديث: | 20231215 |
| DOI: | 10.1097/JU.0000000000003158 |
| PMID: | 36630588 |
| قاعدة البيانات: | MEDLINE |
| تدمد: | 1527-3792 |
|---|---|
| DOI: | 10.1097/JU.0000000000003158 |