Editorial comment

摘要

This report evaluates the evolution of management strategies for clinical Tl renal masses at a single high-volume center from 2005 to 2011 and provides a detailed analysis of the pretreat-ment characteristics associated with each of the approaches (ie, RN, PN, ABL, and AS). The past 6-7 years have been notable for substantial advances in our understanding of the tumor biology of clinical Tl renal masses, the functional implications of renal surgery in this typically elderly patient population that often has pre-existing CKD, and important technical innovations. These developments are reflected in this series by the nearly twofold increases in the use of PN and AS, with RN use decreasing more than fourfold, most recently representing <10% of cases in 2010. The other interesting trend has been a decrease in the use of ABL, which was chosen in only about 5% of cases during the past 4 years, representing a twofold decrease compared with the earlier experience. The authors cite concerns about oncologic efficacy and the need for long-term surveillance as the main reasons for decreased use of ABL; however, at many centers, such as ours, ABL has been partly supplanted by AS in recognition of the limited biologic aggressiveness of most small renal masses.