MP64-03 LOW METASTATIC POTENTIAL OF COMPLEX RENAL CYSTS: THE Case FOR ACTIVE SURVEILLANCE
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Résumé
You have accessJournal of UrologyCME1 Apr 2023MP64-03 LOW METASTATIC POTENTIAL OF COMPLEX RENAL CYSTS: THE Case FOR ACTIVE SURVEILLANCE Hannah Thomas, Shideh Abedi, Toronto, Canada, Thenappan Chandrasekar, PA Philadelphia, Kartik Jhaveri, Toronto, Canada, Johan Bjorklund, Stockholm, Sweden, Douglas Cheung, Michael Jewett, and Antonio Finelli Hannah ThomasHannah Thomas More articles by this author , Shideh AbediShideh Abedi More articles by this author , Toronto Toronto More articles by this author , Canada Canada More articles by this author , Thenappan ChandrasekarThenappan Chandrasekar More articles by this author , PA PhiladelphiaPA Philadelphia More articles by this author , Kartik JhaveriKartik Jhaveri More articles by this author , Toronto Toronto More articles by this author , Canada Canada More articles by this author , Johan BjorklundJohan Bjorklund More articles by this author , Stockholm Stockholm More articles by this author , Sweden Sweden More articles by this author , Douglas CheungDouglas Cheung More articles by this author , Michael JewettMichael Jewett More articles by this author , and Antonio FinelliAntonio Finelli More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003322.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The incidence of incidentally-detected renal cysts is high, ranging from 12% to 61%. While well-defined clinical consensus exists for Bosniak I and II renal cysts, our understanding of best practices for surveillance and management of complex renal cysts remains contended. This study aimed to evaluate key patient and disease-specific outcomes of complex renal cysts across an updated, twenty-year cohort. METHODS: We performed a retrospective chart review of patients diagnosed with Bosniak IIF, III and IV renal cysts from 2001-2013 across three tertiary academic hospitals. Data from date of diagnosis to June 2022 was extracted, including demographics, cyst characteristics, biopsy and surgical/ablative intervention. Primary endpoints were radiologic upgrading (i.e. formal Bosniak upgrading or subjective worsening of radiographic features in same Bosniak class) and cancer-specific mortality. RESULTS: A total of 332 patients with complex renal cysts were included: Bosniak IIF (55.4%, 184/332), Bosniak III (36.4%, 121/332), Bosniak IV (8.1%, 27/332). The majority of patients were male (63.3%, 210/332). Most patients were managed with active surveillance, except Bosniak IV patients where 66.7% (18/27) underwent upfront nephrectomy. Rates of biopsy were similar among Bosniak III and IV groups (22.3%, 27/121 and 22.2%, 6/27). Median follow-up for Bosniak IIF, III and Bosniak IV cysts on active surveillance was 7.8 years (IQR= 3.9-12.4 yrs), 6.6 years (IQR= 3.7-10.1 yrs) and 4.6 years (IQR=3.7-8.6 yrs), respectively. Twenty-eight percent of surgical patients (19/67) experienced peri-operative complications. The rate of radiologic upgrading for Bosniak IIF, III and IV was 7.1% (13/184), 4.9% (6/121) and 3.7% (1/27), respectively (Table 1). Cancer-specific mortality remained at 0.3% (1/332). CONCLUSIONS: Overall, despite lengthy follow-up, the rate of radiologic progression and cancer-specific mortality for complex renal cysts remains low. This analysis challenges conventional views of upfront intervention, particularly for Bosniak III cysts. It appears safe to de-intensify surveillance for complex renal cysts along with transfer of care to primary care providers (with appropriate direction and triggers for re-referral), especially for patients with compatible goals of care. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e881 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hannah Thomas More articles by this author Shideh Abedi More articles by this author Toronto More articles by this author Canada More articles by this author Thenappan Chandrasekar More articles by this author PA Philadelphia More articles by this author Kartik Jhaveri More articles by this author Toronto More articles by this author Canada More articles by this author Johan Bjorklund More articles by this author Stockholm More articles by this author Sweden More articles by this author Douglas Cheung More articles by this author Michael Jewett More articles by this author Antonio Finelli More articles by this author Expand All Advertisement PDF downloadLoading ...
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,006 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,003 | 0,001 |
| Études des sciences et des technologies | 0,002 | 0,002 |
| Communication savante | 0,002 | 0,004 |
| Science ouverte | 0,001 | 0,002 |
| Intégrité de la recherche | 0,006 | 0,006 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,022 | 0,006 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».