Abstract
BackgroundThis study was performed to evaluate the impact of baseline characteristics and treatment methods on the outcome of sporadic renal angiomyolipoma (AML).MethodsThis was a pooled analysis of individual data of 441 patients with AML retrieved from 58 studies and 3 institutional series.ResultsNinety-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).ConclusionsThe 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.
Highlights
This study was performed to evaluate the impact of baseline characteristics and treatment methods on the outcome of sporadic renal angiomyolipoma (AML)
Renal angiomyolipomas (AMLs) are frequent benign renal tumours composed of fat cells, smooth muscle cells, and blood vessels [1,2,3]
Data from each series were independently extracted by the two authors and subsequently cross-checked. This literature search identified a number of small studies with heterogeneous treatment strategies and a lack of treatment-specific data on survival and freedom from re-intervention, which prevented the performance of an aggregate survival meta-analysis
Summary
This study was performed to evaluate the impact of baseline characteristics and treatment methods on the outcome of sporadic renal angiomyolipoma (AML). Renal angiomyolipomas (AMLs) are frequent benign renal tumours composed of fat cells, smooth muscle cells, and blood vessels [1,2,3]. These tumours belong to a family of perivascular epithelioid cell tumours [4]. According to the current guidelines of the European Association of Urology [10], the primary indications for treatment of renal AML are the presence of symptoms or suspected malignancy. The treatment threshold for AML tumours with a diameter of ≥4 cm has recently been disputed
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