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BMC Urol. 2015 Dec 28;15:123. doi: 10.1186/s12894-015-0118-2.

Treatment of renal angiomyolipoma: pooled analysis of individual patient data.

Author information

1
Department of Surgery and Medical Research Center Oulu, Oulu University Hospital and University of Oulu, PO Box 21, 90029 OYS, Oulu, Finland. teele.kuusk@gmail.com.
2
Department of Surgery and Medical Research Center Oulu, Oulu University Hospital and University of Oulu, PO Box 21, 90029 OYS, Oulu, Finland. fausto.biancari@ppshp.fi.
3
Division of Urology, Michigan State University, Grand Rapids, Michigan, USA. blaneppmd@yahoo.com.
4
Division of Urology, Michigan State University, Grand Rapids, Michigan, USA. conrad.tobert@gmail.com.
5
Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA. CAMPBES3@ccf.org.
6
Sheba Medical Center, Tel-Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel. Uri.Rimon@sheba.health.gov.il.
7
Department of Surgery and Medical Research Center Oulu, Oulu University Hospital and University of Oulu, PO Box 21, 90029 OYS, Oulu, Finland. vito.dandrea@uniroma1.it.
8
Department of Surgery and Medical Research Center Oulu, Oulu University Hospital and University of Oulu, PO Box 21, 90029 OYS, Oulu, Finland. aare.mehik@oulu.fi.
9
Department of Surgery and Medical Research Center Oulu, Oulu University Hospital and University of Oulu, PO Box 21, 90029 OYS, Oulu, Finland. markku.vaarala@oulu.fi.

Abstract

BACKGROUND:

This study was performed to evaluate the impact of baseline characteristics and treatment methods on the outcome of sporadic renal angiomyolipoma (AML).

METHODS:

This was a pooled analysis of individual data of 441 patients with AML retrieved from 58 studies and 3 institutional series.

RESULTS:

Ninety-three patients underwent nephrectomy, 163 partial nephrectomy/enucleation, 128 embolisation, 19 cryoablation, 6 radiofrequency ablation, and 32 conservative treatment. Their mean follow-up period was 44.5 months. Patients who experienced major bleeding at presentation had significantly larger tumours than did those without bleeding (mean diameter, 10.1 vs. 5.9 cm, respectively; p < 0.0001). A total of 9.4 % and 26.4 % of bleeding tumours had a diameter of <4 and <6 cm, respectively. A tumour diameter of ≥8.0 cm (hazard ratio, 2.07; 95 % confidence interval, 1.20-4.77) and the treatment method (p = 0.001) were independent predictors of re-intervention. The risk of re-intervention was significantly higher after embolisation, particularly for large tumours (5-year rate of freedom from re-intervention: diameter of ≥8.0 cm, 49.2 %; diameter of <8.0 cm, 74.8 %; p = 0.018). Conservatively treated AMLs had a mean baseline diameter of 3.2 ± 2.7 cm; after 41 months, their mean diameter was 3.7 ± 3.1 cm (p = 0.109).

CONCLUSIONS:

The prevalence of major bleeding is high in sporadic AMLs with a diameter of >6 cm. These results suggest that conservative treatment can be considered in AMLs of <6 cm in diameter. Among current treatment methods, embolisation was associated with a significantly higher risk of re-intervention. Further studies are needed to define risk factors for bleeding and assess the relative benefits of different treatment modalities.

PMID:
26710923
PMCID:
PMC4693425
DOI:
10.1186/s12894-015-0118-2
[Indexed for MEDLINE]
Free PMC Article

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