Markku Vaarala is a consultant for Amgen, Astellas, and Janssen and received a speaker honorarium from Amgen, Astellas, and Novartis. Trial participation: Amgen, Aragon Pharmaceuticals, Astellas, AstraZeneca, Pfizer, Orexo, Millenium Pharmaceuticals, and Janssen. The other authors declare that they have no conflict of interest.
MHV and FB participated in the study design. TK and FB acquired the data. BL, CT, SC, and UR provided the patient cohort data. FB analysed and interpreted the data. MHV, FB, AM, and TK drafted the manuscript. FB, BL, CT, SC, UR, and VD’A critically revised the manuscript for important intellectual content. All authors read and approved the final manuscript.
This study was performed to evaluate the impact of baseline characteristics and treatment methods on the outcome of sporadic renal angiomyolipoma (AML).
This was a pooled analysis of individual data of 441 patients with AML retrieved from 58 studies and 3 institutional series.
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).
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.
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- Treatment of renal angiomyolipoma: pooled analysis of individual patient data
Markku H. Vaarala
- BioMed Central
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