Abstract：
OBJECTIVE: This AUA Guideline focuses on evaluation/counseling/management of adult patients with clinically-localized renal masses suspicious for cancer, including solid-enhancing tumors and Bosniak 3/4 complex-cystic lesions.
METHODS: The Renal Mass and Localized Renal Cancer guideline underwent an update literature review which resulted in the 2021 amendment. When sufficient evidence existed, the body of evidence was assigned a 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: Great progress has been made regarding the evaluation/management of clinically-localized renal masses. These guidelines provide updated, evidence-based recommendations regarding evaluation/counseling including the evolving role of renal-mass-biopsy (RMB). Given great variability of clinical/oncologic/functional characteristics, index patients are not utilized and the panel advocates individualized counseling/management. Options for intervention (partial-nephrectomy (PN), radical-nephrectomy (RN), and thermal-ablation (TA)) are reviewed including recent data about comparative-effectiveness/potential morbidities. Oncologic issues are prioritized while recognizing the importance of functional-outcomes for survivorship. Granular criteria for RN are provided to help reduce overutilization of RN while also avoiding imprudent PN. Priority for PN is recommended for clinical T1a lesions, along with selective utilization of TA, which has good efficacy for tumors≤3.0 cm. Recommendations for genetic-counseling have been revised and considerations for adjuvant-therapies are addressed. Active-surveillance and follow-up after intervention are discussed in an adjunctive article.
CONCLUSIONS: Several factors require consideration during counseling/management of patients with clinically-localized renal masses including general health/comorbidities, oncologic-considerations, functional-consequences, and relative efficacy/potential morbidities of various management-strategies.
METHODS: The Renal Mass and Localized Renal Cancer guideline underwent an update literature review which resulted in the 2021 amendment. When sufficient evidence existed, the body of evidence was assigned a 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: Great progress has been made regarding the evaluation/management of clinically-localized renal masses. These guidelines provide updated, evidence-based recommendations regarding evaluation/counseling including the evolving role of renal-mass-biopsy (RMB). Given great variability of clinical/oncologic/functional characteristics, index patients are not utilized and the panel advocates individualized counseling/management. Options for intervention (partial-nephrectomy (PN), radical-nephrectomy (RN), and thermal-ablation (TA)) are reviewed including recent data about comparative-effectiveness/potential morbidities. Oncologic issues are prioritized while recognizing the importance of functional-outcomes for survivorship. Granular criteria for RN are provided to help reduce overutilization of RN while also avoiding imprudent PN. Priority for PN is recommended for clinical T1a lesions, along with selective utilization of TA, which has good efficacy for tumors≤3.0 cm. Recommendations for genetic-counseling have been revised and considerations for adjuvant-therapies are addressed. Active-surveillance and follow-up after intervention are discussed in an adjunctive article.
CONCLUSIONS: Several factors require consideration during counseling/management of patients with clinically-localized renal masses including general health/comorbidities, oncologic-considerations, functional-consequences, and relative efficacy/potential morbidities of various management-strategies.
摘要：
目的：本AUA指南的重点是评估/咨询/治疗成人患者的临床局限性肾脏肿块可疑癌症，包括实体增强肿瘤和波什尼亚克3/4复杂囊性病变。
方法：肾质量和局部肾癌指南进行了最新文献综述，导致2021年修正案。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：关于临床局部肾脏肿块的评估/管理已经取得了很大进展。这些指南提供了更新，关于评估/咨询的循证建议，包括肾肿块活检的作用（人民币）。鉴于临床/肿瘤/功能特征的巨大变异性，索引患者不被利用，小组提倡个性化咨询/管理。干预选择(肾部分切除术(PN)，根治性肾切除术（RN），和热消融（TA））进行了审查，包括有关比较有效性/潜在发病率的最新数据。肿瘤问题被优先考虑，同时认识到功能结果对生存的重要性。提供RN的粒度标准以帮助减少RN的过度利用,同时还避免不谨慎的PN。临床T1a病变建议优先考虑PN,随着TA的选择性利用，对≤3.0cm的肿瘤有较好的疗效。对遗传咨询的建议进行了修订，并解决了辅助治疗的注意事项。在一篇辅助文章中讨论了干预后的主动监测和随访。
结论：在临床局限性肾脏肿块患者的咨询/管理过程中需要考虑几个因素，包括一般健康/合并症，肿瘤学方面的考虑，功能后果，以及各种管理策略的相对疗效/潜在发病率。
方法：肾质量和局部肾癌指南进行了最新文献综述，导致2021年修正案。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：关于临床局部肾脏肿块的评估/管理已经取得了很大进展。这些指南提供了更新，关于评估/咨询的循证建议，包括肾肿块活检的作用（人民币）。鉴于临床/肿瘤/功能特征的巨大变异性，索引患者不被利用，小组提倡个性化咨询/管理。干预选择(肾部分切除术(PN)，根治性肾切除术（RN），和热消融（TA））进行了审查，包括有关比较有效性/潜在发病率的最新数据。肿瘤问题被优先考虑，同时认识到功能结果对生存的重要性。提供RN的粒度标准以帮助减少RN的过度利用,同时还避免不谨慎的PN。临床T1a病变建议优先考虑PN,随着TA的选择性利用，对≤3.0cm的肿瘤有较好的疗效。对遗传咨询的建议进行了修订，并解决了辅助治疗的注意事项。在一篇辅助文章中讨论了干预后的主动监测和随访。
结论：在临床局限性肾脏肿块患者的咨询/管理过程中需要考虑几个因素，包括一般健康/合并症，肿瘤学方面的考虑，功能后果，以及各种管理策略的相对疗效/潜在发病率。
