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Doctoral Thesis
DOI
https://doi.org/10.11606/T.17.2019.tde-03092019-161532
Document
Author
Full name
Roberto Dias Machado
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
Ribeirão Preto, 2019
Supervisor
Committee
Reis, Rodolfo Borges dos (President)
Molina, Carlos Augusto Fernandes
Faria, Eliney Ferreira
Muglia, Valdair Francisco
Title in Portuguese
Cistos renais bosniak 3 e 4: impacto da vigilância ativa nos escores nefrométricos
Keywords in Portuguese
Bosniak III e IV
Cistos renais
Escore R.E.N.A.L e PADUA
Escores nefrométricos
Abstract in Portuguese
INTRODUÇÃO: O tratamento padrão-ouro para cistos renais complexos (CCRs) Bosniak III e IV é a excisão cirúrgica devido ao alto risco de malignidade. Entretanto, a histologia benigna está presente em 50% dos cistos de Bosniak III e 10% de Bosniak IV. A vigilância ativa (VA) é uma terapia estabelecida para massas renais sólidas pequenas. Muitos autores relataram a segurança e bons resultados oncológicos para VA nos CRCs. Mas, até o momento, não há dados disponíveis na literatura que informem as alterações dos escores de Nefrometria dos CRCs (s-R.E.N.A.L e s-PADUA) em VA. OBJETIVO: Avaliar as alterações no escore de Nefrometria para CCRs Bosniak III e IV em VA com seguimento mínimo de dois anos. PACIENTES E MÉTODOS: Este estudo foi observacional, multicêntrico, retrospectivo. Dados de 101 CRCs foram obtidos de 95 pacientes. Os prontuários médicos foram obtidos de três diferentes instituições: Hospital de Amor Barretos - Fundação Pio XII, Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto - USP e o MD Anderson Cancer Center - EUA. Escores de Nefrometria (R.E.N.A.L e PADUA) foram obtidos revisando-se os exames (TC e RM) por quatro radiologistas e um uro-oncologista, no momento do diagnóstico e da última imagem disponível, com intervalo mínimo de dois anos. A análise estatística foi realizada utilizando-se a versão SPSS com os do teste do Qui-quadrado e de Homogeneidade Marginal. Os dados foram coletados e armazenados na plataforma (REDCap). RESULTADOS: Entre as 101 lesões, 62 eram Bk IV e 39 Bk III. O seguimento médio foi de 4,2 anos. Os cistos Bk IV foram mais prevalentes em homens e os Bk III em mulheres. O tamanho inicial médio dos CRCs foi de 2,77 cm (0,50 - 11,8) e o tamanho médio final dos CRCs foi de 3,0 cm (0,40 - 13,10). De acordo com o tamanho, 19 lesões diminuíram, 45 lesões aumentaram e 37 lesões ficaram estáveis . De acordo com o escore Nefrometria s-R.E.N.A.L: cinco lesões mudaram de categoria, uma (1%) diminuiu a complexidade e quatro (4%) tiveram a complexidade aumentada; utilizando o sP.A.D.U.A sete lesões mudaram de complexidade, em duas lesões (2%) a complexidade diminuiu enquanto em cinco lesões (5%) a complexidade aumentou. A mediana da velocidade de crescimento foi de 0,19 cm/ano e a velocidade de diminuição foi de 0,21 cm/ano. CONCLUSÕES: Após um mínimo de dois anos de acompanhamento, a complexidade das 101 lesões CRCs Bosniak (III e IV) em VA aumentou em 4 lesões (4%) de acordo com s-R.E.N.A.L. e em 5 lesões (5%) de acordo com o s-PADUA
Title in English
Renal cysts bosniak 3 and 4: impact of the active surveillance on nefrometriy scores
Keywords in English
Bosniak III and IV , Nephrometry scores
R.E.N.A.L and PADUA
Renal cysts
Abstract in English
INTRODUCTION: The Golden standard treatment for complex renal cysts (CRCs) Bosniak III and IV is surgical excision due to the high risk of malignancy. However, benign histology is present 50 % of Bosniak III and 10% of Bosniak IV cysts. Active surveillance (AS) is a establish therapy for solid small renal masses. Many authors have been reported the safety and good oncologic outcomes for AS in CRCs. But until now, there is no available data in the literature informing the changes of the CRCs Nephrometry scores (R.E.N.A.L and PADUA) of the lesions on AS. This information could influence the selection of therapy of the CRCs. OBJECTIVE: to evaluate the changes in Nefrometry score for CRCs Bosniak III and IV in AS with a minimum follow-up of two years. PATIENTS AND METHODS: This study was an observational, multicenter, retrospective study. Data from one hundred and one CRCs were obtained from 95 patients. Medical records were obtained from three different institutions: Barretos Hospital of Love - Pio XII Foundation, Hospital das Clínicas, Ribeirão Preto Medical School - USP and the MD Anderson Cancer Center - USA. Nephrometry scores (R.E.N.A.L and s-PADUA) were obtained reviewing the scans (CT and MRI) by four Radiologists and one Uro-oncologist, at the time of diagnosis and the last image available, with a minimal interval of two years. Statistic analysis was performed using SPSS version with Chi square and Marginal Homogeneity tests. For data collection we used (REDCap) platform. RESULTS: Among the 101 lesions, 62 were Bosniak IV and 39 Bosniak III. The mean follow-up was 4.2 years. Bosniak IV cysts were more prevalent in males and Bosniak III in females. The mean CRCs initial size was 2.77 cm (0.50 - 11.8), and the mean final CRCs size was 3.0 cm (0.40 - 13.10). According to size, 19 lesions decreased, 45 lesions increased and 37 lesions were stable after two years. According to the Nephrometry R.E.N.A.L score: five lesions have changed categories, one (1%) decreased complexity and four (4%) had the complexity increased; using the P.A.D.U.A score seven lesions changed complexity, in two lesions (2%) the complexity decreased while in five lesions (5%) the complexity increased. The median growth velocity was 0.19 cm/year and the shrink velocity was 0.21 cm/year. CONCLUSIONS: After a minimum of two years follow-up, the complexity of the one hundred and one CRCs (Bosniak III and IV) on AS increased in 4 lesions (4%) according to the R.E.N.A.L. score and in 5 lesions (5%) according and PADUA score. This information should be also taken in account when the therapeutic options are listed
 
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Publishing Date
2019-11-06
 
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