Objective
To compare oncological and procedural outcomes for renal oncocytic tumors treated
with surgery, thermal ablation, or active surveillance.
Methods
Clinical and pathologic data were collected for consecutive patients with a histologic
diagnosis of oncocytoma, oncocytic neoplasm, or chromophobe renal cell cancer (chRCC)
from 2003 to 2016. Independent pathology and radiology reviews were performed for
this study.
Results
Of 171 patients, tumor histology included oncocytoma (n = 122), chRCC (n = 47), and
oncocytic neoplasm not otherwise specified (n = 2). At the initial diagnosis, 67,
14, and 90 patients were treated with surgery, thermal ablation, and active surveillance.
In 3 of 19 patients (16%) who had biopsy and subsequent surgery, diagnosis changed
from oncocytoma to chRCC. The median follow-up was 39.9 months with no difference
among choices of treatment modalities (P = .33). Of 90 patients who began active surveillance, 32 (36%) switched to active
treatments (19 underwent thermal ablation and 13 underwent surgery). The median linear
growth rate for patients on active surveillance was 1.2 mm/y. No patients who were
managed with active surveillance developed metastatic renal cell cancer (mRCC). mRCC
was identified in 3 patients and was the cause of death in 2 patients. Patients who
developed metastatic disease presented with symptomatic tumors of >4 cm and were treated
with immediate surgery. For oncocytic masses of ≤4 cm (n = 126), the 5-year cancer-specific
survival was 100%.
Conclusion
Renal oncocytic neoplasms have favorable oncological outcomes. Active surveillance
is safe and is the preferred management for small (≤4 cm) oncocytic renal tumors in
selected patients.
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Article info
Publication history
Published online: October 10, 2017
Accepted:
September 20,
2017
Received:
July 14,
2017
Footnotes
Financial Disclosure: Meghan G. Lubner received grant funding from Philips and Ethicon. J. Louis Hinshaw was a consultant for Neuwave Medical. Fred T. Lee, Jr., was a consultant at Ethicon, Inc.; was a consultant, a stockholder, and a member of the Board of Directors at Histosonics, Inc.; and received patents and royalties from Covidien, Inc. The remaining authors declare that they have no relevant financial interests.
Identification
Copyright
© 2017 Elsevier Inc. All rights reserved.
