【摘要翻译】不适合手术治疗的肾肿瘤患者的处理——自然病史，并发症以及转归
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UROLOGY 64: 909–913, 2004.
MANAGEMENT OF RENAL MASSES IN PATIENTS MEDICALLY UNSUITABLE FOR NEPHRECTOMY—NATURAL HISTORY, COMPLICATIONS, AND OUTCOME
GAVIN W. A. LAMB, EMMA J. BROMWICH, PAUL VASEY, AND MICHAEL AITCHISON
From the Department of Urology, Gartnavel General Hospital; and Beatson Oncology Centre, Western Infirmary, Glasgow, United Kingdom
ABSTRACT
Objectives. To examine a group of elderly patients with much larger tumors who were deemed unlikely to survive surgery or who would require dialysis postoperatively to establish the natural history of larger renal tumors if left untreated. Little is known of the growth rate and natural history of renal cancer progression
because the tumor is usually removed in those patients who can tolerate surgery. The only published data have been in relation to unfit patients with small, homogeneous, well-circumscribed tumors less than 4 cm.
Methods. We identified 36 patients whose tumor had not been removed, without evidence of metastasis at diagnosis, from a database of 421 patients with renal cancer. The data were examined retrospectively for symptoms, survival, and size change.
Results. The mean age of the patients treated conservatively was 76.1 years (range 56 to 91), with median tumor size of 6.0 cm (range 3.5 to 20.0) at diagnosis. The median follow-up period was 24 months (range 3 to 136). Of the 36 patients, 13 had died at follow-up, 8 of an unrelated illness and 5 of an unknown cause with no radiologic evidence of progression but severe comorbidity. The median time to death was 9 months (range 3 to 24) after diagnosis. One patient developed metastasis at 132 months and was still alive at 136 months of follow-up. Significant hematuria occurred in 11% of the patients and was successfully managed either conservatively or by embolization. The tumor size was unchanged in most patients during the follow-up period.
Conclusions. In elderly patients, or those with severe comorbidity, conservative management of larger renal masses is a reasonable and safe option.
目的：由于在那些能够耐受手术的患者中，肿瘤通常被切除，因此对肾癌进展的生长率和自然病程知之甚少。唯一有报道的资料也是关于那些小的，质地均匀的，界限清楚的小于4cm的肿瘤。我们通过调查一组不能耐受手术或术后需要透析的较大肾肿瘤的老年患者，建立较大肾肿瘤未经治疗的自然病程。
方法：我们从421例肾癌患者中，挑选出36例。他们的肿瘤未被切除，诊断学上也没有转移的证据。通过回顾性调查获得他们的症状，存活和肿瘤大小变化。
结果：这些保守治疗的患者年龄的中位数为76.1岁（56-91），肿瘤直径的中位数为6.0cm(3.5-20.0)。随访时间的中位数为24个月（3-136）。
36例患者中，13例随访期间死亡，8例死于无关疾病，5例无明显放射学进展证据但有严重合并症的患者死因不明。诊断后死亡时间的中位数为9个月（3-24）。1例患者于132个月发生转移，在136个月的随访时仍然存活。11%的患者出现明显血尿并被通过保守治疗或是栓塞治疗成功处理。随访期间，大多数病人的肿瘤大小没有变化。
结论：在那些老年，或有严重合并症的较大肾肿瘤患者中，保守治疗是一个合理的，安全的选择。
MANAGEMENT OF RENAL MASSES IN PATIENTS MEDICALLY UNSUITABLE FOR NEPHRECTOMY—NATURAL HISTORY, COMPLICATIONS, AND OUTCOME
GAVIN W. A. LAMB, EMMA J. BROMWICH, PAUL VASEY, AND MICHAEL AITCHISON
From the Department of Urology, Gartnavel General Hospital; and Beatson Oncology Centre, Western Infirmary, Glasgow, United Kingdom
ABSTRACT
Objectives. To examine a group of elderly patients with much larger tumors who were deemed unlikely to survive surgery or who would require dialysis postoperatively to establish the natural history of larger renal tumors if left untreated. Little is known of the growth rate and natural history of renal cancer progression
because the tumor is usually removed in those patients who can tolerate surgery. The only published data have been in relation to unfit patients with small, homogeneous, well-circumscribed tumors less than 4 cm.
Methods. We identified 36 patients whose tumor had not been removed, without evidence of metastasis at diagnosis, from a database of 421 patients with renal cancer. The data were examined retrospectively for symptoms, survival, and size change.
Results. The mean age of the patients treated conservatively was 76.1 years (range 56 to 91), with median tumor size of 6.0 cm (range 3.5 to 20.0) at diagnosis. The median follow-up period was 24 months (range 3 to 136). Of the 36 patients, 13 had died at follow-up, 8 of an unrelated illness and 5 of an unknown cause with no radiologic evidence of progression but severe comorbidity. The median time to death was 9 months (range 3 to 24) after diagnosis. One patient developed metastasis at 132 months and was still alive at 136 months of follow-up. Significant hematuria occurred in 11% of the patients and was successfully managed either conservatively or by embolization. The tumor size was unchanged in most patients during the follow-up period.
Conclusions. In elderly patients, or those with severe comorbidity, conservative management of larger renal masses is a reasonable and safe option.
目的：由于在那些能够耐受手术的患者中，肿瘤通常被切除，因此对肾癌进展的生长率和自然病程知之甚少。唯一有报道的资料也是关于那些小的，质地均匀的，界限清楚的小于4cm的肿瘤。我们通过调查一组不能耐受手术或术后需要透析的较大肾肿瘤的老年患者，建立较大肾肿瘤未经治疗的自然病程。
方法：我们从421例肾癌患者中，挑选出36例。他们的肿瘤未被切除，诊断学上也没有转移的证据。通过回顾性调查获得他们的症状，存活和肿瘤大小变化。
结果：这些保守治疗的患者年龄的中位数为76.1岁（56-91），肿瘤直径的中位数为6.0cm(3.5-20.0)。随访时间的中位数为24个月（3-136）。
36例患者中，13例随访期间死亡，8例死于无关疾病，5例无明显放射学进展证据但有严重合并症的患者死因不明。诊断后死亡时间的中位数为9个月（3-24）。1例患者于132个月发生转移，在136个月的随访时仍然存活。11%的患者出现明显血尿并被通过保守治疗或是栓塞治疗成功处理。随访期间，大多数病人的肿瘤大小没有变化。
结论：在那些老年，或有严重合并症的较大肾肿瘤患者中，保守治疗是一个合理的，安全的选择。
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