Higher risk renal angiomyolipomas: Surveillance remains a safe management option Journal Article
| Authors: | Dawidek, M. T.; Villada, J. S. A.; Vazquez-Rivera, K.; Fuchs, H.; Calderon, L. P.; Eismann, L.; Reese, S. W.; Ganz, M.; Ridouani, F.; Ostrovnaya, I.; Touijer, K. A.; Coleman, J. A.; Russo, P.; Hakimi, A. A. |
| Article Title: | Higher risk renal angiomyolipomas: Surveillance remains a safe management option |
| Abstract: | Introduction: This retrospective study furthers our understanding of risk factors associated with hemorrhage and intervention in renal angiomyolipomas (R-AMLs), particularly in larger tumors (≥4 cm) and in childbearing-age (CBA; younger than 50 years) women. The objective was to refine risk stratification and optimize patient management. Methods: Review of our institutional database identified patients with radiographic R-AML from 1997 to 2023. Patient characteristics, R-AML characteristics, and clinical course were collected. Patients were grouped by management trajectories and analyzed across R-AML size, sex, and CBA woman status. Growth rates were modeled using linear mixed-effects regression. Results: Of the 162 patients in this cohort, 22% had large R-AMLs (≥4 cm), of which the majority (66%) were managed with surveillance and a substantial portion (43%) never underwent intervention. The 23% of the cohort who were CBA women were similarly primarily managed with surveillance (74%), and more than half never underwent intervention (53%). The median follow-up on surveillance was 5.4 years. There was a significantly higher modeled growth rate with larger baseline tumor size, but growth rate was not affected by CBA woman status. Most cases of bleeding were in patients with markedly enlarged R-AMLs with multiple risk factors, but there were no serious adverse events. Conclusions: This study is enriched for large R-AMLs and uniquely focuses on CBA women. It reinforces the notion that most large R-AMLs are treated asymptomatically and do not necessarily represent the bleeding risk historically ascribed to them. It suggests that CBA woman status alone should not motivate R-AML treatment. © 2024 by American Urological Association Education and Research, Inc. |
| Keywords: | risk assessment; angiomyolipoma; active surveillance; hemorrhage |
| Journal Title: | Urology Practice |
| Volume: | 12 |
| Issue: | 2 |
| ISSN: | 2352-0779 |
| Publisher: | Lippincott Williams & Wilkins |
| Date Published: | 2025-03-01 |
| Start Page: | 274 |
| End Page: | 280 |
| Language: | English |
| DOI: | 10.1097/upj.0000000000000756 |
| PROVIDER: | scopus |
| PMCID: | PMC11845299 |
| PUBMED: | 39874471 |
| DOI/URL: | |
| Notes: | The MSK Cancer Center Support Grant (P30 CA008748) is acknowledge in the PDF -- Corresponding authors is MSK author: A. Ari Hakimi -- Source: Scopus |
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