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

Treatment of renal angiomyolipoma: pooled analysis of individual patient data

Teele Kuusk  1 , Fausto Biancari  2 , Brian Lane  3 , Conrad Tobert  4 , Steven Campbell  5 , Uri Rimon  6 , Vito D'Andrea  7 , Aare Mehik  8 , Markku H Vaarala  9
Affiliations

Treatment of renal angiomyolipoma: pooled analysis of individual patient data

Teele Kuusk et al. BMC Urol. .

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.

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Figures

Fig. 1
Fig. 1
Literature search flow chart
Fig. 2
Fig. 2
Box plot showing impact of baseline tumour size on severe bleeding. Fifty-four of 441 patients had severe bleeding at presentation (p < 0.0001)
Fig. 3
Fig. 3
Cox proportional hazards model for repeat intervention. The model was created according to different treatment strategies and adjusted for tumour diameter, presence of bleeding, age, and sex. The freedom from re-intervention curves after radiofrequency ablation and nephrectomy are behind the cryoablation curve in the figure
See this image and copyright information in PMC

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