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• W2040228974 abstract "No AccessJournal of UrologyReview article1 Feb 2006The Natural History of Observed Enhancing Renal Masses: Meta-Analysis and Review of the World Literature Sam N. Chawla, Paul L. Crispen, Alexandra L. Hanlon, Richard E. Greenberg, David Y.T. Chen, and Robert G. Uzzo Sam N. ChawlaSam N. Chawla More articles by this author , Paul L. CrispenPaul L. Crispen More articles by this author , Alexandra L. HanlonAlexandra L. Hanlon More articles by this author , Richard E. GreenbergRichard E. Greenberg More articles by this author , David Y.T. ChenDavid Y.T. Chen More articles by this author , and Robert G. UzzoRobert G. Uzzo More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)00148-5AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Standard therapy for an enhancing renal mass is surgical. However, operative treatment may not be plausible in all clinical circumstances. Data on the natural history of untreated enhancing renal lesions is limited but could serve as a decision making resource for patients and physicians. We examined available data on the natural history of observed solid renal masses. Materials and Methods: A Medline review of the literature was performed from 1966 to the present regarding untreated, observed, localized solid renal masses. To these data we added our institutional experience with a total of 61 lesions observed in 49 patients for a minimum of 1 year. Variables examined were initial lesion size at presentation, growth rate, duration of followup, pathological findings and progression to metastatic disease. Overall weighted mean estimates were calculated for lesion size at presentation, growth rate and followup based upon combining single institutional series with complete information. Results: We identified 10 reports from 9 single institutional series in the world literature regarding the natural history of untreated solid localized renal lesions. The series included 6 to 40 patients (mean 25) with a mean followup of 30 months (range 25 to 39). When combined with our institutional data, a total of 286 lesions were analyzed, of which 234 could be included in the meta-analysis. Mean lesion size at presentation was 2.60 cm (median 2.48, range 1.73 to 4.08). Meta-analysis revealed a mean growth rate of 0.28 cm yearly (median 0.28, range 0.09 to 0.86) at a mean followup of 34 months (median 32, range 26 to 39) in all series combined. Pathological confirmation was available in 46% of the cases (131 of 286) and it confirmed 92% (120 of 131) as RCC variants. Evaluable data in this subset of confirmed RCC demonstrated a mean growth rate of 0.40 cm yearly (median 0.35, range 0.42 to 1.6). Lesion size at presentation did not predict the overall growth rate (p = 0.46). Progression to metastatic disease was identified in only 1% of lesions (3 of 286) during followup. Conclusions: The majority of small enhancing renal masses grow at a slow rate when observed. Although metastatic and cancer specific death are low, serial radiographic data alone are insufficient to predict the true natural history of these lesions. Therefore, physicians and patients assume a calculated risk when following these tumors. Basic biological data are needed to assess the natural history of untreated renal masses. References 1 : Renal imaging for diagnosis and staging of renal cell carcinoma. Urol Clin North Am2003; 30: 499. Google Scholar 2 : Prospective evaluation of fine needle aspiration on small, solid renal masses: accuracy and morbidity. Urology1997; 50: 25. Google Scholar 3 : Small renal tumors: natural history, observation strategies and emerging modalities of energy based tumor ablation. Can J Urol2003; 10: 1871. 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Volume 175Issue 2February 2006Page: 425-431 Advertisement Copyright & Permissions© 2006 by American Urological AssociationKeywordsnatural historykidneykidney neoplasmsMetricsAuthor Information Sam N. Chawla More articles by this author Paul L. Crispen More articles by this author Alexandra L. Hanlon More articles by this author Richard E. Greenberg More articles by this author David Y.T. Chen More articles by this author Robert G. Uzzo More articles by this author Expand All Advertisement PDF downloadLoading ..." @default.
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