Active surveillance for renal angiomyolipoma: outcomes and factors predictive of delayed intervention

Abstract

ObjectiveTo present the outcomes of active surveillance (AS) for renal angiomyolipomas (AMLs) and to assess the clinical features predicting delayed intervention of this treatment option. Patients and MethodsWe retrospectively reviewed the outcomes of patients diagnosed with AMLs on computed tomography (CT) who were managed with AS at our institution. The AS protocol consisted of 6-and 12-month, then annual follow-up visits, each one including a physical examination and CT imaging. Discontinuation of AS was defined as the need or decision for an active procedure during the follow-up period. Causes of delayed intervention, as well as the type of active treatment (AT), were recorded. Clinical features at presentation of patients failing AS were compared with those who remained under AS at the time of the last follow-up. Predictive factors of delayed intervention were analysed using univariate and multivariate Cox regression models. ResultsOverall, 130 patients were included in the analysis, of whom 102 (78.5%) were incidentally diagnosed, while 15 (11.5%) and 13 patients (10%) presented with flank pain and haematuria, respectively. After a mean (SD) follow-up of 49 (40) months, 17 patients (13%) discontinued AS and underwent AT. Patients who underwent delayed intervention were more likely to present with a higher body mass index, larger tumours and symptomatic disease. Angioembolization represented the first-line AT after AS (64.7%), whereas partial nephrectomy was adopted in 29.4% of patients. On the univariate analysis, risk factors for delayed intervention included tumour size ≥4 cm, symptoms at diagnosis, and history of concomitant or contralateral kidney disease. On the multivariate analysis, only tumour size and symptoms remained independently associated with discontinuation of AS. ConclusionsTumour size and symptoms at initial presentation were highly predictive of discontinuation of AS in the management of AMLs. Selective angioembolization was the first-line option used for AT after AS was discontinued.

Active surveillance for clinically localized renal tumors: An updated review of current indications and clinical outcomes

“…No significant AS failures or deaths from any cause were reported. 56 These results are comparable with those reported in the smaller series by De Luca et al 53 Conversely, Mues et al did not find statistically significant correlations between clinical predictors (such as tumor dimension, growth rate or symptoms) and the need for active treatment. 52 In that study, among 91 patients diagnosed with AML, 48 were placed on AS as primary management.…”

“…With the aim to answer this relevant question, Ouzaid et al reported outcomes from a retrospective cohort of 130 patients diagnosed with AML on computed tomography imaging and managed with AS at the Glickman Urological and Kidney Institute. 56 The mean patient age was 53.3 ± 16.5 years, and the vast majority of enrolled patients were female (77.7%). A total of 70% of tumors were less than 4 cm at the time of diagnosis, and 28 patients (21%) were symptomatic (flank pain and hematuria).…”

Tuberous sclerosis complex in the Western Cape, South Africa: The clinical presentation features

“…Even though this is also a rational recommendation, it is unlikely to be fullfilled in many parts of subSaharan Africa. [1,2,10] In our group, 3 patients presented with cardiac rhabdomyomas, and 5 had lesions identified after TSC was diagnosed. It is possible that these additional cases reflected limited antenatal assessment, and further highlights the difficulties of early detection in our setting.…”

Selective arterial embolization of symptomatic and asymptomatic renal angiomyolipomas: a retrospective study of safety, outcomes and tumor size reduction

“…Ouzaid et al (69) found that only 13 out of 38 patients with AML >4 cm discontinued active surveillance after 4 years mean follow-up, arguing that treatment for all tumors >4 cm would have resulted in a 65% over-treatment rate and that 67% of symptomatic patients were managed with active surveillance without complications. Bhatt et al (64) found in their series of 447 patients up to 70% of asymptomatic lesions >4 cm with no difference in growth rates for lesions >4 and <4 cm.…”