Active surveillance versus initial surgery in the long-term management of Bosniak IIF–IV cystic renal masses

There may be surgical overtreatment of complex cystic renal masses (CRM). Growing evidence supports active surveillance (AS) for the management for Bosniak IIF–III CRMs. We aimed to evaluate and compare oncological and pathological outcomes of Bosniak IIF–IV CRMs treated by initial surgery (IS) or A...

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Autores principales: Luomala, Lassi, Rautiola, Juhana, Järvinen, Petrus, Mirtti, Tuomas, Nisén, Harry
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Nature Publishing Group UK 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9205856/
https://www.ncbi.nlm.nih.gov/pubmed/35715428
http://dx.doi.org/10.1038/s41598-022-14056-6
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author Luomala, Lassi
Rautiola, Juhana
Järvinen, Petrus
Mirtti, Tuomas
Nisén, Harry
author_facet Luomala, Lassi
Rautiola, Juhana
Järvinen, Petrus
Mirtti, Tuomas
Nisén, Harry
author_sort Luomala, Lassi
collection PubMed
description There may be surgical overtreatment of complex cystic renal masses (CRM). Growing evidence supports active surveillance (AS) for the management for Bosniak IIF–III CRMs. We aimed to evaluate and compare oncological and pathological outcomes of Bosniak IIF–IV CRMs treated by initial surgery (IS) or AS. We identified retrospectively 532 patients with CRM counseled during 2006–2017. IS and AS were delivered to, respectively, 1 and 286 patients in Bosniak IIF, to 54 and 85 patients in III and to 85 and 21 patients in Bosniak IV. Median follow-up was 66 months (IQR 50–96). Metastatic progression occurred for 1 (0.3%) AS patient in Bosniak IIF, 1 IS (1.8%) and 1 AS (1.2%) patient in Bosniak III and 5 IS (3.5%) patients in Bosniak IV, respectively. Overall 5-year metastasis-free survival was 98.9% and cancer-specific survival was 99.6% without statistically significant difference between IS and AS in Bosniak IIF–IV categories. AS did not increase the risk of metastatic spread or cancer-specific mortality in patients with Bosniak IIF–IV. Our data indicate AS in Bosniak IIF and III is safe. Surgery is the primary treatment for Bosniak IV due to its high malignancy rate.
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spelling pubmed-92058562022-06-19 Active surveillance versus initial surgery in the long-term management of Bosniak IIF–IV cystic renal masses Luomala, Lassi Rautiola, Juhana Järvinen, Petrus Mirtti, Tuomas Nisén, Harry Sci Rep Article There may be surgical overtreatment of complex cystic renal masses (CRM). Growing evidence supports active surveillance (AS) for the management for Bosniak IIF–III CRMs. We aimed to evaluate and compare oncological and pathological outcomes of Bosniak IIF–IV CRMs treated by initial surgery (IS) or AS. We identified retrospectively 532 patients with CRM counseled during 2006–2017. IS and AS were delivered to, respectively, 1 and 286 patients in Bosniak IIF, to 54 and 85 patients in III and to 85 and 21 patients in Bosniak IV. Median follow-up was 66 months (IQR 50–96). Metastatic progression occurred for 1 (0.3%) AS patient in Bosniak IIF, 1 IS (1.8%) and 1 AS (1.2%) patient in Bosniak III and 5 IS (3.5%) patients in Bosniak IV, respectively. Overall 5-year metastasis-free survival was 98.9% and cancer-specific survival was 99.6% without statistically significant difference between IS and AS in Bosniak IIF–IV categories. AS did not increase the risk of metastatic spread or cancer-specific mortality in patients with Bosniak IIF–IV. Our data indicate AS in Bosniak IIF and III is safe. Surgery is the primary treatment for Bosniak IV due to its high malignancy rate. Nature Publishing Group UK 2022-06-17 /pmc/articles/PMC9205856/ /pubmed/35715428 http://dx.doi.org/10.1038/s41598-022-14056-6 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Article
Luomala, Lassi
Rautiola, Juhana
Järvinen, Petrus
Mirtti, Tuomas
Nisén, Harry
Active surveillance versus initial surgery in the long-term management of Bosniak IIF–IV cystic renal masses
title Active surveillance versus initial surgery in the long-term management of Bosniak IIF–IV cystic renal masses
title_full Active surveillance versus initial surgery in the long-term management of Bosniak IIF–IV cystic renal masses
title_fullStr Active surveillance versus initial surgery in the long-term management of Bosniak IIF–IV cystic renal masses
title_full_unstemmed Active surveillance versus initial surgery in the long-term management of Bosniak IIF–IV cystic renal masses
title_short Active surveillance versus initial surgery in the long-term management of Bosniak IIF–IV cystic renal masses
title_sort active surveillance versus initial surgery in the long-term management of bosniak iif–iv cystic renal masses
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9205856/
https://www.ncbi.nlm.nih.gov/pubmed/35715428
http://dx.doi.org/10.1038/s41598-022-14056-6
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