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Authors Miller BL, Mankowski Gettle L, Van Roo JR, Ziemlewicz TJ, Best SL, Wells SA, Lubner MG, Hinshaw JL, Lee FT, Nakada SY, Huang W, Abel EJ
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Journal Urology
Publish Date 2017 Oct 10
PubMed ID 29030073
Abstract

To compare oncologic and procedural outcomes for renal oncocytic tumors treated with surgery, thermal ablation or active surveillance.Clinical and pathologic data were collected for consecutive patients with a histological diagnosis of oncocytoma, oncocytic neoplasm or chromophobe renal cell cancers (chRCC) from 2003-2016. Independent pathology and radiology review was performed for this study.Of 171 patients, tumor histology included oncocytoma (n=122), chRCC (n=47) and oncocytic neoplasm not otherwise specified (n=2). At initial diagnosis, 67, 14, and 90 patients were treated with surgery, thermal ablation and active surveillance. In 3/19 (16%) patients who had biopsy and subsequent surgery, diagnosis changed from oncocytoma to chRCC. Median follow up was 39.9 months with no difference among choices of treatment modalities (p=0.33). Of 90 patients who began active surveillance, 32 (36%) switched to active treatments (19 thermal ablation and 13 surgery). Median linear growth rate for patients on active surveillance was 1.2 mm/yr. No patients who were managed with active surveillance developed metastatic RCC (mRCC). mRCC was identified in 3 patients and mRCC was cause of death in 2 patients. Patients who developed metastatic disease presented with symptomatic tumors >4cm and were treated with immediate surgery. For oncocytic masses ≤4 cm (n=126), 5-year cancer-specific survival was 100%.Renal oncocytic neoplasms have favorable oncologic outcomes. Active surveillance is safe and is a preferred management for small (≤4 cm) oncocytic renal tumors in selected patients.


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