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Comparative Analysis of Surgery, Thermal Ablation, and Active Surveillance for Renal Oncocytic Neoplasms
Brady L Miller1, Lori Mankowski Gettle2, Jason R Van Roo1
1Department of Urology, University of Wisconsin, Madison, WI.
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.
Insights
Active surveillance is a safe management option for small renal oncocytic tumors (≤4cm), showing favorable oncological outcomes. This approach is preferred for selected patients, with no cases of metastatic disease developing under surveillance.
Area of Science:
- Urology
- Oncology
- Nephrology
Background:
- Renal oncocytic tumors encompass oncocytomas, oncocytic neoplasms, and chromophobe renal cell carcinoma (chRCC).
- Treatment decisions involve surgery, thermal ablation, or active surveillance, with varying oncological and procedural outcomes.
Purpose of the Study:
- To compare oncological and procedural outcomes for renal oncocytic tumors.
- Evaluate the efficacy of surgery, thermal ablation, and active surveillance in managing these tumors.
Main Methods:
- Retrospective analysis of clinical and pathologic data from 171 patients diagnosed between 2003 and 2016.
- Independent pathology and radiology reviews were conducted.
- Patients were categorized by treatment: surgery, thermal ablation, or active surveillance.
Main Results:
- No significant difference in oncological outcomes among treatment modalities (P=.33).
- 36% of patients on active surveillance eventually required active treatment.
- No metastatic renal cell cancer (mRCC) developed in patients managed with active surveillance; 5-year cancer-specific survival was 100% for tumors ≤4cm.
Conclusions:
- Renal oncocytic neoplasms demonstrate favorable oncological prognoses.
- Active surveillance is a safe and preferred management strategy for selected patients with small (≤4cm) renal oncocytic tumors.