目的:描述AML的自然史,肾脏AML的临床结果和长期随访期间的治疗需求。
方法:对2001年至2019年间通过计算机断层扫描或核磁共振诊断为AML的患者进行回顾性研究,并进行了至少两次随访图像。临床和影像学变量,需要干预,记录并发症和随访时间。统计学分析采用SPSS22.0。
结果:纳入111例患者和145例AML患者。中位随访时间为6.17年(范围为0.7-18.1,IQR11.8-12.2)。诊断时的中位肿瘤大小为13毫米(IQR7.5-30),24(16.4%)≥4厘米。大多数表现为偶然发现(85.5%);在3例(2.1%)中,表现为自发性腹膜后血肿.干预的主要指征是50%的尺寸≥4cm。18名(12%)患者接受了首次干预,紧急3栓塞15例,肾部分切除术3例。有5例记录了重新干预的需要:2例接受了部分肾切除术和2例全肾切除术;一名患者需要新的紧急栓塞。在非手术患者中,43%的大小减少或没有变化,虽然增加了57%,年增长中位数为0.13毫米(IQR-0.11至0.73)。诊断时≥4cm(0.16mm)的肿瘤中位生长与<4厘米(0.13毫米)(p=0.9)。
结论:这项研究的结果表明,AML在长期随访中通常表现出缓慢进展的临床过程。此外,我们的观察,这对肿瘤大小作为不良临床结局的可靠预测指标表示怀疑,主张在监测频率和成像方式的选择上都采用不太密集的监测策略。
OBJECTIVE: To describe the natural history of AML, the clinical results and the need for treatment during long-term follow-up of renal AML.
METHODS: Retrospective study of patients diagnosed with AML by computed tomography or nuclear magnetic resonance between 2001 and 2019, with at least two follow-up images. Clinical and imaging variables, need for intervention, complications and follow-up time were recorded. Statistical analysis was performed using SPSS 22.0.
RESULTS: 111 patients and 145 AML were included. The median follow-up was 6.17 years (range 0.7-18.1, IQR 11.8-12.2). The median tumor size at diagnosis was 13 mm (IQR 7.5-30), with 24 (16.4%) being ≥ 4 cm. Most presented as an incidental finding (85.5%); in 3 (2.1%) cases, the presentation was as a spontaneous retroperitoneal hematoma. The main indication for intervention was size ≥ 4 cm in 50%. Eighteen (12%) patients received a first intervention, being urgent in 3. Embolization was performed in 15 cases and partial nephrectomy in 3. The need for reintervention was recorded in five: two underwent partial nephrectomy and two total nephrectomy; one patient required a new urgent embolization. Of the non-operated patients, 43% decreased in size or did not change, while 57% increased, with the median annual growth being 0.13 mm (IQR - 0.11 to 0.73). There were no differences in the median growth in tumors measuring ≥ 4 cm (0.16 mm) at diagnosis vs. < 4 cm (0.13 mm) (p = 0.9).
CONCLUSIONS: The findings of this study suggest that AML typically demonstrate a slow-progressing clinical course during long-term follow-up. Moreover, our observations, which cast doubt on tumor size as a reliable predictor of adverse clinical outcomes, advocate for a less intensive monitoring strategy in both monitoring frequency and choice of imaging modality.