Abstract：
OBJECTIVE: This AUA Guideline focuses on active surveillance (AS) and follow-up after intervention for adult patients with clinically-localized renal masses suspicious for cancer, including solid enhancing tumors and Bosniak 3/4 complex cystic lesions.
METHODS: In January 2021, the Renal Mass and Localized Renal Cancer guideline underwent additional amendment based on a current literature-search. This literature search retrieved additional studies published between July 2016 to October 2020 using the same Key Questions and search criteria from the Renal Mass and Localized Renal Cancer guideline. When sufficient evidence existed, the body of evidence was assigned strength-rating of A (high), B (moderate), or C (low) for support of Strong, Moderate, or Conditional Recommendations. In the absence of sufficient evidence, additional information is provided as Clinical Principles and Expert Opinions (table 1[Table: see text]).
RESULTS: AS with potential delayed intervention should be considered for patients with solid, enhancing renal masses <2cm or Bosniak 3-4 lesions that are predominantly-cystic. Shared decision-making about AS should consider risks of intervention/competing mortality versus the potential oncologic benefits of intervention. Recommendations for renal mass biopsy and considerations for periodic clinical/imaging-based surveillance are discussed. After intervention, risk-based surveillance protocols are defined incorporating clinical/laboratory evaluation and abdominal/chest imaging designed to detect local/systemic recurrences and possible treatment-related sequelae, such as progressive renal-insufficiency.
CONCLUSIONS: AS is a potential management strategy for some patients with clinically-localized renal masses that requires careful risk-assessment, shared decision-making and periodic-reassessment. Follow-up after intervention is designed to identify local/systemic recurrences and potential treatment-related sequelae. A risk-based approach should be prioritized with selective use of laboratory/imaging resources.
METHODS: In January 2021, the Renal Mass and Localized Renal Cancer guideline underwent additional amendment based on a current literature-search. This literature search retrieved additional studies published between July 2016 to October 2020 using the same Key Questions and search criteria from the Renal Mass and Localized Renal Cancer guideline. When sufficient evidence existed, the body of evidence was assigned strength-rating of A (high), B (moderate), or C (low) for support of Strong, Moderate, or Conditional Recommendations. In the absence of sufficient evidence, additional information is provided as Clinical Principles and Expert Opinions (table 1[Table: see text]).
RESULTS: AS with potential delayed intervention should be considered for patients with solid, enhancing renal masses <2cm or Bosniak 3-4 lesions that are predominantly-cystic. Shared decision-making about AS should consider risks of intervention/competing mortality versus the potential oncologic benefits of intervention. Recommendations for renal mass biopsy and considerations for periodic clinical/imaging-based surveillance are discussed. After intervention, risk-based surveillance protocols are defined incorporating clinical/laboratory evaluation and abdominal/chest imaging designed to detect local/systemic recurrences and possible treatment-related sequelae, such as progressive renal-insufficiency.
CONCLUSIONS: AS is a potential management strategy for some patients with clinically-localized renal masses that requires careful risk-assessment, shared decision-making and periodic-reassessment. Follow-up after intervention is designed to identify local/systemic recurrences and potential treatment-related sequelae. A risk-based approach should be prioritized with selective use of laboratory/imaging resources.
摘要：
目的：本AUA指南的重点是对临床局限性肾脏肿块可疑癌症的成年患者进行主动监测（AS）和干预后的随访，包括实体增强肿瘤和波什尼亚克3/4复杂囊性病变。
方法：2021年1月，根据目前的文献检索，对肾脏质量和局部肾癌指南进行了进一步修订。该文献检索检索了2016年7月至2020年10月期间发表的其他研究，使用相同的关键问题和来自肾质量和局部肾癌指南的搜索标准。如果有足够的证据，证据体被指定为强度等级A（高），B(中等),或C（低）支持强，中等,或有条件的建议。在缺乏充分证据的情况下,其他信息作为临床原则和专家意见提供（表1[表：见正文]）。
结果：AS患者应考虑潜在的延迟干预，增强肾肿块<2cm或Bosniak3-4个主要是囊性病变。关于AS的共同决策应考虑干预/竞争性死亡率的风险与干预的潜在肿瘤学益处。讨论了肾脏肿块活检的建议以及定期进行基于临床/影像学的监测的注意事项。干预后,定义了基于风险的监测方案，包括临床/实验室评估和腹部/胸部成像，旨在检测局部/全身复发和可能的治疗相关后遗症。如进行性肾功能不全。
结论：AS是一些需要仔细风险评估的临床局限性肾脏肿块患者的潜在管理策略，共同决策和定期重新评估。干预后的随访旨在确定局部/全身复发和潜在的治疗相关后遗症。基于风险的方法应优先考虑选择性使用实验室/成像资源。
方法：2021年1月，根据目前的文献检索，对肾脏质量和局部肾癌指南进行了进一步修订。该文献检索检索了2016年7月至2020年10月期间发表的其他研究，使用相同的关键问题和来自肾质量和局部肾癌指南的搜索标准。如果有足够的证据，证据体被指定为强度等级A（高），B(中等),或C（低）支持强，中等,或有条件的建议。在缺乏充分证据的情况下,其他信息作为临床原则和专家意见提供（表1[表：见正文]）。
结果：AS患者应考虑潜在的延迟干预，增强肾肿块<2cm或Bosniak3-4个主要是囊性病变。关于AS的共同决策应考虑干预/竞争性死亡率的风险与干预的潜在肿瘤学益处。讨论了肾脏肿块活检的建议以及定期进行基于临床/影像学的监测的注意事项。干预后,定义了基于风险的监测方案，包括临床/实验室评估和腹部/胸部成像，旨在检测局部/全身复发和可能的治疗相关后遗症。如进行性肾功能不全。
结论：AS是一些需要仔细风险评估的临床局限性肾脏肿块患者的潜在管理策略，共同决策和定期重新评估。干预后的随访旨在确定局部/全身复发和潜在的治疗相关后遗症。基于风险的方法应优先考虑选择性使用实验室/成像资源。
