Clinical Management of Synchronous and Metachronous Renal Lesions in Patients With Oncocytoma Treated With Nephrectomy: A 30-Year Single-Center Experience.
The natural history of renal oncocytoma (RO) following surgical resection remains unclear. We examined a cohort of post-nephrectomy patients with RO, focusing on the management of synchronous and metachronous tumors and their clinical course under surveillance.
This retrospective, single-institution study analyzed patients from 1990 to 2020 with at least 24 months of follow-up. Patient characteristics and management of synchronous and metachronous tumors were recorded. Cox regression identified risk factors for metachronous tumors, while Kaplan-Meier and log-rank tests assessed metachronous-free survival (MFS).
Among 328 patients (median follow-up: 109 months), 19% (n = 63) had synchronous renal tumors on preoperative imaging. Of these, 27 underwent additional procedures, revealing renal cell carcinoma (RCC)/cortical neoplasm (n = 7), benign lesions (n = 5), or secondary RO (n = 13). Two specimens were unavailable. Metachronous renal lesions developed in 8.5% (n = 28), with 18 undergoing active surveillance. Among 8 patients undergoing biopsy or surgery, 3 had RCC/cortical neoplasm, 4 had RO, and 1 specimen was inconclusive. 5-year MFS were 98.8% in patients with a single lesion at diagnosis and 88% for patients with presence of synchronous renal lesions (P = .004). Higher BMI (HR 1.09, CI 1.01-1.17, P = .026) and synchronous lesions at diagnosis (HR 2.67, CI 1.16-6.14, P = .021) were significant risk factors for metachronous tumors.
Patients with RO have a very low risk of harboring RCC in synchronous or metachronous lesions, supporting active surveillance as a safe strategy. However, those with synchronous kidney tumors at diagnosis face an increased risk of metachronous disease and may require closer monitoring.
This retrospective, single-institution study analyzed patients from 1990 to 2020 with at least 24 months of follow-up. Patient characteristics and management of synchronous and metachronous tumors were recorded. Cox regression identified risk factors for metachronous tumors, while Kaplan-Meier and log-rank tests assessed metachronous-free survival (MFS).
Among 328 patients (median follow-up: 109 months), 19% (n = 63) had synchronous renal tumors on preoperative imaging. Of these, 27 underwent additional procedures, revealing renal cell carcinoma (RCC)/cortical neoplasm (n = 7), benign lesions (n = 5), or secondary RO (n = 13). Two specimens were unavailable. Metachronous renal lesions developed in 8.5% (n = 28), with 18 undergoing active surveillance. Among 8 patients undergoing biopsy or surgery, 3 had RCC/cortical neoplasm, 4 had RO, and 1 specimen was inconclusive. 5-year MFS were 98.8% in patients with a single lesion at diagnosis and 88% for patients with presence of synchronous renal lesions (P = .004). Higher BMI (HR 1.09, CI 1.01-1.17, P = .026) and synchronous lesions at diagnosis (HR 2.67, CI 1.16-6.14, P = .021) were significant risk factors for metachronous tumors.
Patients with RO have a very low risk of harboring RCC in synchronous or metachronous lesions, supporting active surveillance as a safe strategy. However, those with synchronous kidney tumors at diagnosis face an increased risk of metachronous disease and may require closer monitoring.
Authors
Eismann Eismann, Reese Reese, Dawidek Dawidek, Calderon Calderon, Aulitzky Aulitzky, Vazquez-Rivera Vazquez-Rivera, Coleman Coleman, Stief Stief, Reznik Reznik, Russo Russo, Hakimi Hakimi
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