【摘要翻译】肾癌相关进展之四：肾癌的预后情况
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1.不适合肾切除术的肾肿瘤 ---- 疾病自然史、并发症、结果
Lamb GW, Bromwich EJ, Vasey P, Aitchison M.
Urology. 2004 Nov;64(5):909-13
目的：分析一些老年肿瘤患者的情况。这些患者或者被认为不能耐受手术，或者接受透析治疗后未对肿瘤进行处理。由于能接受手术的患者的肿瘤被切除，因此对有关肿瘤进展时肿瘤增长率及肿瘤疾病自然史的资料了解很少。现有的资料仅仅是边界清楚的小于 4cm 的小肿瘤的数据。方法：我们从 421 名肾癌患者中挑选出未被切除肿瘤、而且没有肿瘤转移证据的 36 名患者。我们回顾了这些患者的症状、存活率和肿瘤大小。结果：接受保守治疗的患者平均年龄为 76.1 岁（ 56-91 岁），诊断时肿瘤大小中位数为 6.0cm （ 3.5-20cm ）。随访时间中位数为 24 个月（ 3-136 个月）。 36 名患者中， 13 名患者在随访期间死亡（ 8 名患者因其他疾病死亡； 5 名患者死亡时无肿瘤进展的放射学证据，但有严重的伴发症）。从诊断到死亡所需时间中位数为 9 个月（ 3-24 个月）。有 1 名患者在 132 个月时出现肿瘤转移，随访第 136 个月时还依然存活。 11% 的患者出现血尿症状，通过保守治疗或栓塞治疗症状得到缓解。在随访期间，大部分患者的肿瘤大小未出现变化。结论：对于老年患者及有严重伴发症的患者，肾肿瘤的保守治疗是合理和安全的。
Urology. 2004 Nov;64(5):909-13. Related Articles, Links
Management of renal masses in patients medically unsuitable for nephrectomy--natural history, complications, and outcome.
Lamb GW, Bromwich EJ, Vasey P, Aitchison M.
Department of Urology, Gartnavel General Hospital, Glasgow, United Kingdom.
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.
Lamb GW, Bromwich EJ, Vasey P, Aitchison M.
Urology. 2004 Nov;64(5):909-13
目的：分析一些老年肿瘤患者的情况。这些患者或者被认为不能耐受手术，或者接受透析治疗后未对肿瘤进行处理。由于能接受手术的患者的肿瘤被切除，因此对有关肿瘤进展时肿瘤增长率及肿瘤疾病自然史的资料了解很少。现有的资料仅仅是边界清楚的小于 4cm 的小肿瘤的数据。方法：我们从 421 名肾癌患者中挑选出未被切除肿瘤、而且没有肿瘤转移证据的 36 名患者。我们回顾了这些患者的症状、存活率和肿瘤大小。结果：接受保守治疗的患者平均年龄为 76.1 岁（ 56-91 岁），诊断时肿瘤大小中位数为 6.0cm （ 3.5-20cm ）。随访时间中位数为 24 个月（ 3-136 个月）。 36 名患者中， 13 名患者在随访期间死亡（ 8 名患者因其他疾病死亡； 5 名患者死亡时无肿瘤进展的放射学证据，但有严重的伴发症）。从诊断到死亡所需时间中位数为 9 个月（ 3-24 个月）。有 1 名患者在 132 个月时出现肿瘤转移，随访第 136 个月时还依然存活。 11% 的患者出现血尿症状，通过保守治疗或栓塞治疗症状得到缓解。在随访期间，大部分患者的肿瘤大小未出现变化。结论：对于老年患者及有严重伴发症的患者，肾肿瘤的保守治疗是合理和安全的。
Urology. 2004 Nov;64(5):909-13. Related Articles, Links
Management of renal masses in patients medically unsuitable for nephrectomy--natural history, complications, and outcome.
Lamb GW, Bromwich EJ, Vasey P, Aitchison M.
Department of Urology, Gartnavel General Hospital, Glasgow, United Kingdom.
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.
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