Objective

To analyze the experience performing active surveillance (AS) of small renal masses (SRMs) in our center and to correlate the evolution of SRMs under AS with clinical and radiological findings.

Methods

Patients on AS between January 2012 until May 2020 for SRMs in our center have been included. Growth rate (GR) per year was analyzed and correlated with radiographic features. Patients with growth kinetics higher than 5mm/year during follow up were offered active treatment.

Results

73 patients were included in AS: the mean age was 75.7 years, a mean initial tumour size of 21.2 mm, and a mean growth rate of 2.05 mm/year. Around 60 % had an ASA score of 3. The tumor size did not change over time in 43% of cases; in 4% we noticed a regression in size and in 52% of cases growth during follow-up (38% 1-5mm/year and 14% more than 5 mm/year).

Delayed active treatment was indicated in 16 (21%) of cases. Treatment applied was as following: 2 radiofrequency ablations, 6 radical and 8 partial nephrectomies.

A weak correlation was found between initial size and growth rate (r = 0.38, P = 0.02). No significant association was detected regarding any of the analyzed radiological findings and GR.

With a mean follow up time of 33 months none of the patients presented metastatic progression.

Conclusion

Active surveillance is a feasible option for management of SRMs in selected patients without jeopardizing oncological safety. In our series, no clinical or radiological characteristics for predicting tumour growth were found.

中文翻译：

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主动监测下肾脏小肿块的临床和放射学发现

客观的

分析我们中心对小肾肿块 (SRM) 进行主动监测 (AS) 的经验，并将 AS 下 SRM 的演变与临床和放射学发现相关联。

方法

2012 年 1 月至 2020 年 5 月期间在我们中心接受 SRM 治疗的 AS 患者已包括在内。分析每年的增长率 (GR) 并与放射学特征相关联。对随访期间生长动力学高于 5mm/年的患者提供积极治疗。

结果

73 名患者被纳入 AS：平均年龄为 75.7 岁，平均初始肿瘤大小为 21.2 毫米，平均增长率为 2.05 毫米/年。大约 60% 的 ASA 评分为 3。在 43% 的病例中，肿瘤大小没有随时间变化；在 4% 的情况下，我们注意到在随访期间大小的消退和 52% 的病例增长（38% 1-5 毫米/年，14% 超过 5 毫米/年）。

16 例 (21%) 的病例表明需要延迟积极治疗。应用的治疗如下：2次射频消融，6次根治性和8次部分肾切除术。

发现初始大小和增长率之间存在弱相关性（r = 0.38，P  = 0.02）。没有检测到任何分析的放射学发现和 GR 的显着关联。

平均随访时间为 33 个月，没有患者出现转移进展。

结论

在不危及肿瘤安全性的情况下，主动监测是在选定患者中管理 SRM 的可行选择。在我们的系列中，没有发现预测肿瘤生长的临床或放射学特征。