Активное наблюдение опухолей почки, накапливающих рентгеноконтрастное вещество

Introduction: Prompt surgical excision remains the standard of care for clinically localized enhancing renal tumors, for this reason the natural history of untreated renal cell carcinoma (RCC) has not been established. In order to increase our understanding of the natural history of RCC we reviewed our experience with the active surveillance of enhancing renal tumors. Methods: We reviewed our renal cancer database for enhancing renal masses that were radiographically observed for a period of at least 12 months. Variables examined included patient age, gender, lesion size on presentation, radiographic tumor characteristics, duration of active surveillance, linear tumor growth rate, incidence, type of surgical intervention, and surgical pathology. Results: 109 patients with 124 sporadic enhancing renal tumors were identified undergoing a period of active surveillance of at least 12 months. Mean patient age was 69.8 years (median 73, range 35—87). Mean duration of active surveillance was 33.4 months (median 26, range 12—156). Multifocal disease was present in 9% (10/109) patients on presentation. Tumor size on presentation was a mean of 2.61 cm (median 2.0, range 0.4—12.0). Overall mean tumor growth rate was 0.28 cm/yr (median 0.21, range -1.4—2.47). Observed linear growth rates were independent of patient age, gender, tumor size on presentation, and radiographic characteristics (solid versus cystic), p > 0.05. Of the patients initiating a period of active surveillance 36% (39/109) eventually underwent definitive therapy. Extirpative and ablative therapies were used in 72% (28/39) and 28% (11/39) of the patients undergoing surgical intervention, respectively. Malignant pathology was present in 90% (35/39) of the patients undergoing treatment. Of the malignant tumors evaluated, 68% were clear cell RCC. Conclusions: Our current series reveals that the majority of small enhancing renal tumors show a slow interval growth and they are malignant. The investigation and development of clinical and radiographic predictors of future tumor growth would be of great benefit in order to avoid unnecessary intervention in selected patients.