Active surveillance versus initial surgery in the long-term management of Bosniak IIF-IV cystic renal masses

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Luomala , L , Rautiola , J , Järvinen , P , Mirtti , T & Nisen , H 2022 , ' Active surveillance versus initial surgery in the long-term management of Bosniak IIF-IV cystic renal masses ' , Scientific Reports , vol. 12 , no. 1 , 10184 . https://doi.org/10.1038/s41598-022-14056-6

Title: Active surveillance versus initial surgery in the long-term management of Bosniak IIF-IV cystic renal masses
Author: Luomala, Lassi; Rautiola, Juhana; Järvinen, Petrus; Mirtti, Tuomas; Nisen, Harry
Contributor organization: HUS Abdominal Center
Urologian yksikkö
Clinicum
University of Helsinki
Department of Surgery
Research Program in Systems Oncology
HUSLAB
HUS Diagnostic Center
Date: 2022-06-17
Language: eng
Number of pages: 7
Belongs to series: Scientific Reports
ISSN: 2045-2322
DOI: https://doi.org/10.1038/s41598-022-14056-6
URI: http://hdl.handle.net/10138/346456
Abstract: There may be surgical overtreatment of complex cystic renal masses (CRM). Growing evidence supports active surveillance (AS) for the management for Bosniak IIF-III CRMs. We aimed to evaluate and compare oncological and pathological outcomes of Bosniak IIF-IV CRMs treated by initial surgery (IS) or AS. We identified retrospectively 532 patients with CRM counseled during 2006-2017. IS and AS were delivered to, respectively, 1 and 286 patients in Bosniak IIF, to 54 and 85 patients in III and to 85 and 21 patients in Bosniak IV. Median follow-up was 66 months (IQR 50-96). Metastatic progression occurred for 1 (0.3%) AS patient in Bosniak IIF, 1 IS (1.8%) and 1 AS (1.2%) patient in Bosniak III and 5 IS (3.5%) patients in Bosniak IV, respectively. Overall 5-year metastasis-free survival was 98.9% and cancer-specific survival was 99.6% without statistically significant difference between IS and AS in Bosniak IIF-IV categories. AS did not increase the risk of metastatic spread or cancer-specific mortality in patients with Bosniak IIF-IV. Our data indicate AS in Bosniak IIF and III is safe. Surgery is the primary treatment for Bosniak IV due to its high malignancy rate.
Subject: CLASSIFICATION
3126 Surgery, anesthesiology, intensive care, radiology
Peer reviewed: Yes
Rights: cc_by
Usage restriction: openAccess
Self-archived version: publishedVersion


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