FRINK Linked Data Fragments server

Matches in SemOpenAlex for { <https://semopenalex.org/work/W3214917837> ?p ?o ?g. }

• W3214917837 endingPage "656" @default.
• W3214917837 startingPage "655" @default.
• W3214917837 abstract "In this issue of the BJUI, two papers from the Tran group, based at the Royal Free London NHS Foundation Trust, provide evidence to support initial active surveillance (AS) of renal oncocytomas [1] while demonstrating that this approach is not universally accepted across the urological community [2]. Their paper, ‘Renal oncocytoma: landscape of diagnosis and management’, presents the results from a survey of 68, predominately high-volume, renal surgeons from across the globe. It showed that clinicians were more likely to offer conservative management for biopsy-proven renal oncocytomas when the masses were small, or the patients were older or had comorbidities [2]. Such an approach is accepted by many, even for malignant renal tumours, faced with these tumour and patient characteristics, given the likely low risk of adverse outcome. However, the agreement on AS was not universal and there was less consensus when the tumours were larger, or the patients were younger. Although not assessed in the study, this divergent practice may be greater still if a larger cohort of surgeons were surveyed across more countries or healthcare systems, or there was greater representation from lower-volume surgeons. The lack of universal acceptance of AS as the optimal treatment for renal oncocytomas may stem from the diagnostic uncertainty of the renal biopsy and, indeed, only 29% of respondents in the survey routinely perform renal biopsy in small renal masses. Concordance between renal biopsy results demonstrating oncocytoma with final resection pathology was only 64.5% in a systematic review and meta-analysis, although the numbers included are small and there was a lack of clarity on the full biopsy assessment process [3]. This diagnostic discordance is likely to be attributable to the overlapping features of oncocytoma with malignant chromophobe RCC (ChRCC), particularly the eosinophilic variant, and hybrid oncocytoma-chromophobe tumours. However, even with the risk of mis-labelling a potentially malignant ChRCC as oncocytoma, the risk of metastasis of a small T1a ChRCC is extremely low [4] and may still warrant an AS approach. While renal biopsies are safe [5] and can identify rare aggressive malignant small renal tumours, alternative diagnostic methods may be more acceptable to both patients and clinicians. Imaging techniques offer promise, with 99mTc-sestamibi single-photon emission CT/CT able to reliably differentiate benign and low-grade renal tumours from malignant renal cancers [6], and the Tran group plan to evaluate this in the NHS in a prospective study [2]. Diffusion-weighted MRI has also been shown to be able to differentiate subtypes of small renal masses, including oncocytomas and ChRCCs, although prospective validation is also required [7]. For those who do undergo biopsy, use of artificial intelligence techniques and automated analysis of histology slides to reduce inter-reporter variability [8] or additional molecular markers may improve confidence in the diagnosis of oncocytoma. There are promising results from transcriptomic, genomic and, potentially most interestingly, methylation studies to differentiate oncocytoma from ChRCC. A recent study has shown that a 30-marker methylation profile can distinguish oncocytoma from ChRCC with an area under the curve between 0.87 and 0.96, as well as differentiating oncocytoma from other RCC subtypes [9]. If diagnostic certainty could be improved, perhaps through use of a combination of imaging and biopsy, it might encourage clinicians to recommend AS for patients with oncocytoma, potentially with less rigorous follow-up, or even allow them to be discharged. Nevertheless, even if there is certainty in the diagnosis of oncocytoma, clinicians must be confident that they understand the natural history of the disease and that their patients are not going to come to harm without treatment. In this issue, Neves et al. [1] demonstrate that AS of oncocytoma up to 7 cm is safe, with no disease-related deaths and with preservation of renal function during surveillance even with tumour growth. Furthermore, no patients developed symptoms, adding to the growing evidence in support of AS particularly for smaller oncocytomas. This is in contrast to the small but significant risk of death (0.1%) or significant morbidity (Clavien–Dindo grade ≥3a complications 5%) associated with partial nephrectomy reported in the literature [10]. However, the median follow-up of the patients with oncocytomas reported in this paper is a modest 29 months and longer-term outcomes would be welcome. Caution should also be taken with regard to the surveillance of larger oncocytomas, given the relatively small number in this cohort, which was likely to be subject to selection bias. This is highlighted by the number of patients who proceeded directly to treatment without AS and the significant proportion of patients with a high Charlson comorbidity index (CCI) who may be appropriate for AS or watchful waiting even in the presence of RCC given their likely short life expectancy (median CCI=3 with 10-year overall survival of 77%, but Q3 CCI= 5 with a 10-year overall survival of 22% and any patients with a CCI have a 10-year overall survival of 0%). This potential selection bias also raises the question of who should proceed directly to treatment and which parameters should prompt treatment during AS. Larger tumours, faster-growing tumours, tumours where there remains diagnostic uncertainty; particularly in younger and fitter patients, seems intuitive but these issues have not been addressed in a scientific manner. Furthermore, we still do not know the optimal imaging technique, frequency, and duration for follow-up. Nor do we know the quality-of-life impact of surveillance compared to definitive treatment for patients with oncocytomas. In addition, while there have been studies suggesting improved cost-effectiveness for surveillance compared with treatment in small renal cancers, the applicability of this for patients with oncocytomas, who may require less follow-up after definitive treatment, needs to be confirmed. The work presented in this issue will be enough to support the AS approach taken by many for managing oncocytomas already, and will encourage others to consider this option for their patients. It also highlights the many uncertainties and areas for further research and development. The Tran group should be commended for bringing these issues to the forefront and attempting to answer some of these key questions. None declared." @default.
• W3214917837 created "2021-12-06" @default.
• W3214917837 creator A5065565113 @default.
• W3214917837 creator A5087379820 @default.
• W3214917837 date "2021-12-01" @default.
• W3214917837 modified "2023-10-16" @default.
• W3214917837 title "Active surveillance for renal oncocytoma is likely to be safe, but there are many unanswered questions" @default.
• W3214917837 cites W1561562996 @default.
• W3214917837 cites W1898273395 @default.
• W3214917837 cites W1924981906 @default.
• W3214917837 cites W1989687576 @default.
• W3214917837 cites W2568792929 @default.
• W3214917837 cites W2998314120 @default.
• W3214917837 cites W3012505568 @default.
• W3214917837 cites W3089214058 @default.
• W3214917837 cites W3165098839 @default.
• W3214917837 cites W3165786888 @default.
• W3214917837 doi "https://doi.org/10.1111/bju.15565" @default.
• W3214917837 hasPubMedId "https://pubmed.ncbi.nlm.nih.gov/34856059" @default.
• W3214917837 hasPublicationYear "2021" @default.
• W3214917837 type Work @default.
• W3214917837 sameAs 3214917837 @default.
• W3214917837 citedByCount "0" @default.
• W3214917837 crossrefType "journal-article" @default.
• W3214917837 hasAuthorship W3214917837A5065565113 @default.
• W3214917837 hasAuthorship W3214917837A5087379820 @default.
• W3214917837 hasBestOaLocation W32149178371 @default.
• W3214917837 hasConcept C126322002 @default.
• W3214917837 hasConcept C126838900 @default.
• W3214917837 hasConcept C141071460 @default.
• W3214917837 hasConcept C142724271 @default.
• W3214917837 hasConcept C160798450 @default.
• W3214917837 hasConcept C177713679 @default.
• W3214917837 hasConcept C2775934546 @default.
• W3214917837 hasConcept C2777430276 @default.
• W3214917837 hasConcept C2780091579 @default.
• W3214917837 hasConcept C2780674462 @default.
• W3214917837 hasConcept C2781087799 @default.
• W3214917837 hasConcept C54847362 @default.
• W3214917837 hasConcept C61434518 @default.
• W3214917837 hasConcept C71924100 @default.
• W3214917837 hasConcept C72563966 @default.
• W3214917837 hasConceptScore W3214917837C126322002 @default.
• W3214917837 hasConceptScore W3214917837C126838900 @default.
• W3214917837 hasConceptScore W3214917837C141071460 @default.
• W3214917837 hasConceptScore W3214917837C142724271 @default.
• W3214917837 hasConceptScore W3214917837C160798450 @default.
• W3214917837 hasConceptScore W3214917837C177713679 @default.
• W3214917837 hasConceptScore W3214917837C2775934546 @default.
• W3214917837 hasConceptScore W3214917837C2777430276 @default.
• W3214917837 hasConceptScore W3214917837C2780091579 @default.
• W3214917837 hasConceptScore W3214917837C2780674462 @default.
• W3214917837 hasConceptScore W3214917837C2781087799 @default.
• W3214917837 hasConceptScore W3214917837C54847362 @default.
• W3214917837 hasConceptScore W3214917837C61434518 @default.
• W3214917837 hasConceptScore W3214917837C71924100 @default.
• W3214917837 hasConceptScore W3214917837C72563966 @default.
• W3214917837 hasIssue "6" @default.
• W3214917837 hasLocation W32149178371 @default.
• W3214917837 hasLocation W32149178372 @default.
• W3214917837 hasOpenAccess W3214917837 @default.
• W3214917837 hasPrimaryLocation W32149178371 @default.
• W3214917837 hasRelatedWork W193716692 @default.
• W3214917837 hasRelatedWork W1987325187 @default.
• W3214917837 hasRelatedWork W2011593671 @default.
• W3214917837 hasRelatedWork W2062496355 @default.
• W3214917837 hasRelatedWork W2370719878 @default.
• W3214917837 hasRelatedWork W2418037318 @default.
• W3214917837 hasRelatedWork W2613390762 @default.
• W3214917837 hasRelatedWork W2959754319 @default.
• W3214917837 hasRelatedWork W4300996708 @default.
• W3214917837 hasRelatedWork W2407901429 @default.
• W3214917837 hasVolume "128" @default.
• W3214917837 isParatext "false" @default.
• W3214917837 isRetracted "false" @default.
• W3214917837 magId "3214917837" @default.
• W3214917837 workType "article" @default.