Résultats de la surveillance active des angiomyolipomes sporadiques du rein de plus de 4 cm : un plaidoyer en faveur de la surveillance active

Abstract

Active surveillance (AS) of sporadic renal angiomyolipomas (AML) is under-utilised because of an old dogma fearing a life-threatening retroperitoneal hemorrhage when tumour size exceeds 4cm. The objective of this study was to report the outcome of AS in patients with sporadic AML greater than 4cm. The results of AS in 35 patients managed for sporadic renal AML greater than 4cm were analysed. During AS, tumour growth, occurrence of new symptoms and/or complications, discontinuation of AS protocol, reason for discontinuation as well as subsequent treatment options were reported. Within a median follow-up of 36months, 16 (46%) patients discontinued AS at the end of the study period (mean follow-up 55±66, median 36months). Patients who discontinued AS were more symptomatic at diagnosis but had similar age, mean tumour size and sex ratio. Active treatment-free survival was 66% at 5years. Retroperitoneal hemorrhage was reported in 3 (8.5%) patients. None of these bleedings required transfusion or monitoring in an intensive care unit. Other reasons for discontinuation were pain (37%), patient preference (19), changes in the radiological appearance of the tumour (19%), and hematuria (6%). This study showed that AS in AML bearing patients was feasible even in the setting of tumours larger than 4cm. More than 50% of the patients were still on AS at 5 years. Discontinuation of AS was not related to bleeding complications in most cases. 3.