Cancer UrologyCancer UrologyОнкоурология1726-97761996-1812Publishing House ABV Press7710.17650/1726-9776-2012-8-1-23-30DIAGNOSIS AND TREATMENT OF URINARY SYSTEM TUMORS. RENAL CANCERДИАГНОСТИКА И ЛЕЧЕНИЕ ОПУХОЛЕЙ МОЧЕПОЛОВОЙ СИСТЕМЫ. Рак почкиACTIVE OBSERVATION TACTICS IN PATIENTS WITH KIDNEY NEOPLASMSТАКТИКА АКТИВНОГО НАБЛЮДЕНИЯ У БОЛЬНЫХ С НОВООБРАЗОВАНИЯМИ ПОЧКИAlekseevB. Ya.АлексеевБ. Я.
Russian Federation

Department of Urology with a Course of Oncourology, People’s Friendship University of Russia, Moscow

кафедра урологии с курсом онкоурологии ФПК МР РУДН, Москва

byalekseev@mail.ruKalpinskiyA. S.КалпинскийА. С.
Russian Federation

Department of Urology with a Course of Oncourology, People’s Friendship University of Russia, Moscow

кафедра урологии с курсом онкоурологии ФПК МР РУДН, Москва

byalekseev@mail.ruP.A. Herzen Moscow Oncology Research InstituteМНИОИ им. П.А. Герцена300320128123302607201426072014https://oncourology.abvpress.ru/oncur/article/view/77

As of now, about 40-60% of the first detected kidney tumors are accidentally diagnosed. These are most often asymptomatic small kidney tumors (SKT) without distant metastases; 15–20% of them are benign. A number of studies have revealed that kidney malignant tumors grow slowly and spread extremely rarely, as evidenced by a histological study. These and other data formed the basis for the active observation tactic that became possible and acceptable in well-selected patients, in elderly patients with SKT and severe comorbidity in particular.

В настоящее время около 40−60 % первично выявленных опухолей почки диагностируют случайно. Чаще всего это бессимптомные маленькие опухоли почки (МОП) без отдаленных метастазов, 15−20 % из них доброкачественные. В ряде исследований выявлено, что даже подтвержденные результатами гистологического исследования злокачественные опухоли почки растут медленно и метастазируют крайне редко. Эти и другие данные легли в основу тактики активного наблюдения, которая стала возможной и допустимой у четко отобранных больных, в частности у пожилых пациентов с МОП и тяжелой сопутствующей патологией.

active observation tacticasymptomatic and small kidney tumorsтактика активного наблюдениябессимптомные и маленькие опухоли почки1. Hollingsworth J.M., Miller D.C., Daignault S., Hollenbeck B.K. Rising incidence of small renalmasses: a need to reassess treatment effect. J Natl Cancer Inst 2006;98:1331−4.Hollingsworth J.M., Miller D.C., Daignault S., Hollenbeck B.K. Rising incidence of small renalmasses: a need to reassess treatment effect. J Natl Cancer Inst 2006;98:1331−4.2. Lane B.R., Abouassaly R., Gao T. et al. Active treatment of localized renal tumors may not impact overall survival in patients aged 75 years or older. Cancer 2010;116:3119−26.Lane B.R., Abouassaly R., Gao T. et al. Active treatment of localized renal tumors may not impact overall survival in patients aged 75 years or older. Cancer 2010;116:3119−26.3. Luciani L.G., Cestari R., Tallarigo C. Incidental renal cell carcinoma — age and stage characterization and clinical implications: study of 1092 patients (1982−1997). Urology 2000;56:58−62.Luciani L.G., Cestari R., Tallarigo C. Incidental renal cell carcinoma — age and stage characterization and clinical implications: study of 1092 patients (1982−1997). Urology 2000;56:58−62.4. Moinzadeh A., Gill I.S., Finelli A. et al. Laparoscopic partial nephrectomy: 3-year followup. J Urol 2006;175:459−62.Moinzadeh A., Gill I.S., Finelli A. et al. Laparoscopic partial nephrectomy: 3-year followup. J Urol 2006;175:459−62.5. Frank I., Blute M.L., Cheville J.C. et al. Solid renal tumors: an analysis of pathological features related to tumor size. J Urol 2003;170:2217−20.Frank I., Blute M.L., Cheville J.C. et al. Solid renal tumors: an analysis of pathological features related to tumor size. J Urol 2003;170:2217−20.6. Volpe A., Panzarella T., Rendon R.A. et al. The natural history of incidentally detected small renal masses. Cancer 2004;100:738−45.Volpe A., Panzarella T., Rendon R.A. et al. The natural history of incidentally detected small renal masses. Cancer 2004;100:738−45.7. Rendon R.A., Stanietzky N., Panzarella T. et al. The natural history of small renal masses. J Urol 2000;164:1143−7.Rendon R.A., Stanietzky N., Panzarella T. et al. The natural history of small renal masses. J Urol 2000;164:1143−7.8. Fujimoto N., Sugita A., Terasawa Y., Kato M. Observations on the growth rate of renal cell carcinoma. Int J Urol 1995; 2:71−6.Fujimoto N., Sugita A., Terasawa Y., Kato M. Observations on the growth rate of renal cell carcinoma. Int J Urol 1995; 2:71−6.9. Bosniak M.A. Observation of small incidentally detected renal masses. Semin Urol Oncol 1995;13:267−72.Bosniak M.A. Observation of small incidentally detected renal masses. Semin Urol Oncol 1995;13:267−72.10. Bosniak M.A., Birnbaum B.A., Krinsky G.A.,Waisman J. Small renal parenchymal neoplasms: further observations on growth. Radiology 1995;197:589−97.Bosniak M.A., Birnbaum B.A., Krinsky G.A.,Waisman J. Small renal parenchymal neoplasms: further observations on growth. Radiology 1995;197:589−97.11. Oda T., Miyao N., Takahashi A. et al. Growth rates of primary and metastatic lesions of renal cell carcinoma. Int J Urol 2001;8:473−7.Oda T., Miyao N., Takahashi A. et al. Growth rates of primary and metastatic lesions of renal cell carcinoma. Int J Urol 2001;8:473−7.12. Kassouf W., Aprikian A.G., Laplante M., Tanguay S. Natural history of renal masses followed expectantly. J Urol 2004;171:111–3.Kassouf W., Aprikian A.G., Laplante M., Tanguay S. Natural history of renal masses followed expectantly. J Urol 2004;171:111–3.13. Wehle M.J., Thiel D.D., Petrou S.P. et al. Conservative management of incidental contrast-enhancing renal masses as safe alternative to invasive therapy. Urology 2004; 64:49−52.Wehle M.J., Thiel D.D., Petrou S.P. et al. Conservative management of incidental contrast-enhancing renal masses as safe alternative to invasive therapy. Urology 2004; 64:49−52.14. Kato M., Suzuki T., Suzuki Y. et al. Natural history of small renal cell carcinoma: evaluation of growth rate, histological grade, cell proliferation and apoptosis. J Urol 2004;172:863−6.Kato M., Suzuki T., Suzuki Y. et al. Natural history of small renal cell carcinoma: evaluation of growth rate, histological grade, cell proliferation and apoptosis. J Urol 2004;172:863−6.15. Lamb G.W., Bromwich E.J., Vasey P., Aitchison M. Management of renal masses in patients medically unsuitable for nephrectomy–natural history, complications, and outcome. Urology 2004;64:909−13.Lamb G.W., Bromwich E.J., Vasey P., Aitchison M. Management of renal masses in patients medically unsuitable for nephrectomy–natural history, complications, and outcome. Urology 2004;64:909−13.16. Sowery R.D., Siemens D.R. Growth characteristics of renal cortical tumors in patientsmanaged by watchful waiting. Can J Urol 2004;11:2407−10.Sowery R.D., Siemens D.R. Growth characteristics of renal cortical tumors in patientsmanaged by watchful waiting. Can J Urol 2004;11:2407−10.17. Rendon R.A., Jewett M.A. Expectant management for the treatment of small renal masses. Urol Oncol 2006;24: 62−7.Rendon R.A., Jewett M.A. Expectant management for the treatment of small renal masses. Urol Oncol 2006;24: 62−7.18. Chawla S.N., Crispen P.L., Hanlon A.L. et al. The natural history of observed enhancing renal masses: meta-analysis and review of the world literature. J Urol 2006; 175:425−31.Chawla S.N., Crispen P.L., Hanlon A.L. et al. The natural history of observed enhancing renal masses: meta-analysis and review of the world literature. J Urol 2006; 175:425−31.19. Kouba E., Smith A., McRackan D. et al. Watchful waiting for solid renal masses: insight into the natural history and results of delayed intervention. J Urol 2007;177:466−70.Kouba E., Smith A., McRackan D. et al. Watchful waiting for solid renal masses: insight into the natural history and results of delayed intervention. J Urol 2007;177:466−70.20. Kunkle D.A., Crispen P.L., Chen D.Y. et al. Enhancing renal masses with zero net growth during active surveillance. J Urol 2007;177:849−53.Kunkle D.A., Crispen P.L., Chen D.Y. et al. Enhancing renal masses with zero net growth during active surveillance. J Urol 2007;177:849−53.21. Rendon R.A., Jewett M.A. Expectant management for the treatment of small renal masses. Urol Oncol 2006;24:62−7.Rendon R.A., Jewett M.A. Expectant management for the treatment of small renal masses. Urol Oncol 2006;24:62−7.22. Frank I., Blute M.L., Cheville J.C. et al. Solid renal tumors: an analysis of pathological features related to tumor size. J Urol 2003;170:2217−20.Frank I., Blute M.L., Cheville J.C. et al. Solid renal tumors: an analysis of pathological features related to tumor size. J Urol 2003;170:2217−20.23. Van Poppel H., Da Pozzo L., Albrecht W. et al. A prospective randomized EORTC intergroup phase 3 study comparing the complications of elective nephron-sparing surgery and radical nephrectomy for low-stage renal cell carcinoma. Eur Urol 2007;51:1606−15.Van Poppel H., Da Pozzo L., Albrecht W. et al. A prospective randomized EORTC intergroup phase 3 study comparing the complications of elective nephron-sparing surgery and radical nephrectomy for low-stage renal cell carcinoma. Eur Urol 2007;51:1606−15.24. Gill I.S., Matin S.F., Desai M.M. et al. Comparative analysis of laparoscopic versus open partial nephrectomy for renal tumors in 200 patients. J Urol 2003;170:64−8.Gill I.S., Matin S.F., Desai M.M. et al. Comparative analysis of laparoscopic versus open partial nephrectomy for renal tumors in 200 patients. J Urol 2003;170:64−8.25. Schlomer B., Figenshau R.S. et al. Pathological features of renal neoplasms classified by size and symptomatology. J Urol 2006;176:1317−20.Schlomer B., Figenshau R.S. et al. Pathological features of renal neoplasms classified by size and symptomatology. J Urol 2006;176:1317−20.26. Remzi M., Katzenbeisser D.,Waldert M. et al. Renal tumour size measured radiologically before surgery is an unreliable variable for predicting histopathological features: benign tumours are not necessarily small. BJU Int 2007;99:1002−6.Remzi M., Katzenbeisser D.,Waldert M. et al. Renal tumour size measured radiologically before surgery is an unreliable variable for predicting histopathological features: benign tumours are not necessarily small. BJU Int 2007;99:1002−6.27. Karakiewicz P.I., Lewinshtein D.J., Chun F.K.-H. et al. Tumor size improves the accuracy of TNM predictions in patients with renal cancer. Eur Urol 2006; 50:521−9.Karakiewicz P.I., Lewinshtein D.J., Chun F.K.-H. et al. Tumor size improves the accuracy of TNM predictions in patients with renal cancer. Eur Urol 2006; 50:521−9.28. Remzi M., Ozsoy M., Klingler H.C. et al. Are small renal tumors harmless? Analysis of histopathological features according to tumors 4 cm or less in diameter. J Urol 2006; 176:896−9.Remzi M., Ozsoy M., Klingler H.C. et al. Are small renal tumors harmless? Analysis of histopathological features according to tumors 4 cm or less in diameter. J Urol 2006; 176:896−9.29. Hsu R.M., Chan D.Y., Siegelman S.S. Small renal cell carcinomas: correlation of size with tumor stage, nuclear grade, and histologic subtype. AJR Am J Roentgenol 2004;182:551−7.Hsu R.M., Chan D.Y., Siegelman S.S. Small renal cell carcinomas: correlation of size with tumor stage, nuclear grade, and histologic subtype. AJR Am J Roentgenol 2004;182:551−7.30. Minardi D., Lucarini G., Mazzucchelli R. et al. Prognostic role of Fuhrman grade and vascular endothelial growth factor in pT1a clear cell carcinoma in partial nephrectomy specimens. J Urol 2005;174:1208−12.Minardi D., Lucarini G., Mazzucchelli R. et al. Prognostic role of Fuhrman grade and vascular endothelial growth factor in pT1a clear cell carcinoma in partial nephrectomy specimens. J Urol 2005;174:1208−12.31. Crispen P.L., Wong Y.N., Greenberg R.E. et al. Predicting growth of solid renal masses under active surveillance. Urol Oncol 2008; 26:555−9.Crispen P.L., Wong Y.N., Greenberg R.E. et al. Predicting growth of solid renal masses under active surveillance. Urol Oncol 2008; 26:555−9.32. Abouassaly R., Lane B.R., Novick A.C. Active surveillance of renal masses in elderly patients. J Urol 2008;180:505−8.Abouassaly R., Lane B.R., Novick A.C. Active surveillance of renal masses in elderly patients. J Urol 2008;180:505−8.33. Crispen P.L., Viterbo R., Boorjian S.A. et al. Natural history, growth kinetics and outcomes of untreated clinically localized renal tumors under active surveillance. Cancer 2009;115:2844−52.Crispen P.L., Viterbo R., Boorjian S.A. et al. Natural history, growth kinetics and outcomes of untreated clinically localized renal tumors under active surveillance. Cancer 2009;115:2844−52.34. Abou Youssif T., Kassouf W., Steinberg J. et al. Active surveillance for selected patients with renal masses: updated results with long-term follow-up. Cancer 2007; 110:1010−4.Abou Youssif T., Kassouf W., Steinberg J. et al. Active surveillance for selected patients with renal masses: updated results with long-term follow-up. Cancer 2007; 110:1010−4.35. Rosales J.C., Haramis G., Moreno J. et al. Active surveillance for renal cortical neoplasms. J Urol 2010;183:1698−702.Rosales J.C., Haramis G., Moreno J. et al. Active surveillance for renal cortical neoplasms. J Urol 2010;183:1698−702.36. Beisland C., Hjelle K.M., Reisaeter L.A.R., Bostad L. Observation should be considered as an alternative in management of renal masses in older and comorbid patients. Eur Urol 2009; 55:1419−29.Beisland C., Hjelle K.M., Reisaeter L.A.R., Bostad L. Observation should be considered as an alternative in management of renal masses in older and comorbid patients. Eur Urol 2009; 55:1419−29.37. Crispen P.L., Viterbo R., Fox E.B. et al. Delayed intervention of sporadic renal masses undergoing active surveillance. Cancer 2008; 112:1051−7.Crispen P.L., Viterbo R., Fox E.B. et al. Delayed intervention of sporadic renal masses undergoing active surveillance. Cancer 2008; 112:1051−7.38. Jewett M., Finelli A., Link I. et al. Active surveillance of small renal masses: a prospective muti-center Canadian Uro-Oncology Group trial. J Urol 2009; 181(Suppl 4):320.Jewett M., Finelli A., Link I. et al. Active surveillance of small renal masses: a prospective muti-center Canadian Uro-Oncology Group trial. J Urol 2009; 181(Suppl 4):320.39. Jewett M.A.S., Mattar K., Basiuk J. et al. Active Surveillance of Small RenalMasses: Progression Patterns of Early Stage Kidney Cancer. Eur Urol 2011; 60:39−44.Jewett M.A.S., Mattar K., Basiuk J. et al. Active Surveillance of Small RenalMasses: Progression Patterns of Early Stage Kidney Cancer. Eur Urol 2011; 60:39−44.40. Jewett M.A.S. Stockle The motion: surveillance is an option for renal cancer. Eur Urol 2006;50:1363−6.Jewett M.A.S. Stockle The motion: surveillance is an option for renal cancer. Eur Urol 2006;50:1363−6.41. Yates D.R., Roupret M. Small renal mass and low-risk prostate cancer: any more for active surveillance? Eur Urol 2011; doi:10.1016/j.eururo.2011.04.002.Yates D.R., Roupret M. Small renal mass and low-risk prostate cancer: any more for active surveillance? Eur Urol 2011; doi:10.1016/j.eururo.2011.04.002.42. Mason R.J., Abdolell M., Trottier G. Growth kinetics of renal masses: analysis of a prospective cohort of patients undergoing active surveillance. Eur Urol 2011;59:863−7.Mason R.J., Abdolell M., Trottier G. Growth kinetics of renal masses: analysis of a prospective cohort of patients undergoing active surveillance. Eur Urol 2011;59:863−7.