影像診斷腎臟囊腫之積極監測與醫療介入的病理及臨床結果

林瑞穎、劉冠麟、林政鋒、林承家、陳文祥、吳翊豪、陳鴻毅

基隆長庚醫院 外科部 泌尿科

Pathological and Clinical Outcomes in an Active Surveillance and Intervention Cohort of Radiographically Renal Cysts

Jui-Ying Lin, Kuan-Lin Liu, Cheng-Feng Lin, Cheng-Chia Lin, Wen-Hsiang Chen, Yi-Hao Wu, Hong-Yi Chen

Divisions of Urology, Department of Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan

Purpose:

We evaluated oncologic risks in the cohort of Asian patients with radiographic cystic renal lesions who underwent active surveillance or surgical intervention.

Materials and Methods:

We enrolled 190 radiographically confirmed renal cystic lesions, which was classified as Bosniak score (2019 version) ≥  2F, from the medical database of Keelung, Taipei and Linkou Chang Gung Memorial Hospital since 2000/1 to 2023/11. The lesions managed with either active surveillance (AS) ± delayed surgical intervention or immediate surgical intervention. Association of radiographical characteristics and pathology was evaluated.

Results:

  We identified 190 radiographically confirmed renal cystic lesion in 179 patients. 167 renal lesions underwent active surveillance, in which 17 were proceeded delayed intervention eventually. 23 lesions managed surgical intervention. Of these, 40 were resected (n=29, 16 radical nephrectomy vs 13 partial nephrectomy or other intervention (n=11). Pathologically, 65% (n=19) demonstrated malignant pathology. Of intervention cohort, intermediate surgical intervention was associated with higher Bosniak score (P<0.00). On active surveillance, 5 cystic lesions progressed according to Bosniak score based on CT/MRI image. The longest time from diagnosis to progression of these progressive lesion was 24 months. One of these 5 cystic lesion underwent radical nephrectomy, which pathological report showed benign cyst, and the other do surveillance or loss follow-up. No recurrence was found in both surveillance group and intervention group.

Conclusion:

  Over 50% of resected cystic renal lesions which classified as Boasniak IV demonstrated malignant pathology. No patient had a significant progression beyond 24 months. Despite this finding, active surveillance ±  delayed intervention is a safe and effective management option for most radiographic cystic renal lesions