Brady L Miller1, Lori Mankowski Gettle2, Jason R Van Roo1, Timothy J Ziemlewicz2, Sara L Best1, Shane A Wells2, Meghan G Lubner2, J Louis Hinshaw3, Fred T Lee3, Stephen Y Nakada3, Wei Huang4, E Jason Abel5. 1. Department of Urology, University of Wisconsin, Madison, WI. 2. Department of Radiology, University of Wisconsin, Madison, WI. 3. Department of Urology, University of Wisconsin, Madison, WI; Department of Radiology, University of Wisconsin, Madison, WI. 4. Department of Pathology, University of Wisconsin, Madison, WI. 5. Department of Urology, University of Wisconsin, Madison, WI; Department of Radiology, University of Wisconsin, Madison, WI. Electronic address: abel@urology.wisc.edu.
Abstract
OBJECTIVE: To compare oncological and procedural outcomes for renal oncocytic tumors treated with surgery, thermal ablation, or active surveillance. METHODS: Clinical and pathologic data were collected for consecutive patients with a histologic diagnosis of oncocytoma, oncocytic neoplasm, or chromophobe renal cell cancer (chRCC) from 2003 to 2016. Independent pathology and radiology reviews were performed for this study. RESULTS: Of 171 patients, tumor histology included oncocytoma (n = 122), chRCC (n = 47), and oncocytic neoplasm not otherwise specified (n = 2). At the initial diagnosis, 67, 14, and 90 patients were treated with surgery, thermal ablation, and active surveillance. In 3 of 19 patients (16%) who had biopsy and subsequent surgery, diagnosis changed from oncocytoma to chRCC. The median follow-up was 39.9 months with no difference among choices of treatment modalities (P = .33). Of 90 patients who began active surveillance, 32 (36%) switched to active treatments (19 underwent thermal ablation and 13 underwent surgery). The median linear growth rate for patients on active surveillance was 1.2 mm/y. No patients who were managed with active surveillance developed metastatic renal cell cancer (mRCC). mRCC was identified in 3 patients and was the cause of death in 2 patients. Patients who developed metastatic disease presented with symptomatic tumors of >4 cm and were treated with immediate surgery. For oncocytic masses of ≤4 cm (n = 126), the 5-year cancer-specific survival was 100%. CONCLUSION: Renal oncocytic neoplasms have favorable oncological outcomes. Active surveillance is safe and is the preferred management for small (≤4 cm) oncocytic renal tumors in selected patients.
OBJECTIVE: To compare oncological and procedural outcomes for renal oncocytic tumors treated with surgery, thermal ablation, or active surveillance. METHODS: Clinical and pathologic data were collected for consecutive patients with a histologic diagnosis of oncocytoma, oncocytic neoplasm, or chromophobe renal cell cancer (chRCC) from 2003 to 2016. Independent pathology and radiology reviews were performed for this study. RESULTS: Of 171 patients, tumor histology included oncocytoma (n = 122), chRCC (n = 47), and oncocytic neoplasm not otherwise specified (n = 2). At the initial diagnosis, 67, 14, and 90 patients were treated with surgery, thermal ablation, and active surveillance. In 3 of 19 patients (16%) who had biopsy and subsequent surgery, diagnosis changed from oncocytoma to chRCC. The median follow-up was 39.9 months with no difference among choices of treatment modalities (P = .33). Of 90 patients who began active surveillance, 32 (36%) switched to active treatments (19 underwent thermal ablation and 13 underwent surgery). The median linear growth rate for patients on active surveillance was 1.2 mm/y. No patients who were managed with active surveillance developed metastatic renal cell cancer (mRCC). mRCC was identified in 3 patients and was the cause of death in 2 patients. Patients who developed metastatic disease presented with symptomatic tumors of >4 cm and were treated with immediate surgery. For oncocytic masses of ≤4 cm (n = 126), the 5-year cancer-specific survival was 100%. CONCLUSION:Renal oncocytic neoplasms have favorable oncological outcomes. Active surveillance is safe and is the preferred management for small (≤4 cm) oncocytic renal tumors in selected patients.
Authors: Michael Baboudjian; Daniel Moser; Takafumi Yanagisawa; Bastien Gondran-Tellier; Eva M Compérat; Damien Ambrosetti; Laurent Daniel; Cyrille Bastide; Shahrokh F Shariat; Eric Lechevallier; Pietro Diana; Alberto Breda; Benjamin Pradere; Romain Boissier Journal: Eur Urol Open Sci Date: 2022-05-19
Authors: Patrick D McGillivray; Daiki Ueno; Aydin Pooli; Neil Mendhiratta; Jamil S Syed; Kevin A Nguyen; Peter G Schulam; Peter A Humphrey; Adebowale J Adeniran; Paul C Boutros; Brian Shuch Journal: Eur Urol Date: 2020-09-21 Impact factor: 20.096