Renal Mass and Localized Renal Cancer: Evaluation, Management, and Follow-Up: AUA Guideline: Part I
- Study type
- Clinical guideline
- Study name
- AUA Renal Mass and Localized Renal Cancer 2021
- Design
- Evidence-based clinical practice guideline (American Urological Association, AUA) with an updated literature review in 2021
- Sample size
- Not applicable (clinical practice guideline)
- Source
- Journal of Urology · 2021
In plain words
This guideline helps doctors make the best decision about a lump in the kidney that may be cancer and has not yet spread to other parts of the body. Treatment should be chosen for each patient individually, taking into account general health, other illnesses and kidney function. For small tumours (T1a), removing only part of the kidney is usually preferred, and in some patients destroying the tumour with heat is also a good option. Be sure to talk to your treating doctor about the best approach for you.
Key points
Key guideline recommendations
- Level of evidence in the full guideline
Because of the wide variation in clinical, oncological and functional characteristics, no index patient is used, and counselling and management should be individualised.
- Level of evidence in the full guideline
For clinical T1a lesions, partial nephrectomy is prioritised.
- Level of evidence in the full guideline
Thermal ablation should be used selectively; it has good efficacy for tumours ≤3.0 cm.
- Level of evidence in the full guideline
Specific criteria for performing radical nephrectomy are given to reduce its overuse while avoiding injudicious partial nephrectomy.
Study population
Adult patients with clinically localised renal masses suspicious for cancer, including contrast-enhancing solid tumours and Bosniak 3 and 4 complex cystic lesions.
Endpoints
This document is a clinical practice guideline and has no trial endpoint. Its aim is to provide evidence-based recommendations for the evaluation, counselling and management of localised renal masses. Recommendations are graded by strength of evidence: A (high), B (moderate) or C (low) for strong, moderate or conditional recommendations. Where evidence was insufficient, information is given as "Clinical Principles" and "Expert Opinion".
Safety and side effects
The abstract gives no specific figures for grade ≥3 complications. The guideline refers to recent data on potential complications of partial nephrectomy, radical nephrectomy and thermal ablation and considers functional (renal) outcomes important for patient survival. Details in the full guideline.
Clinical significance and place in guidelines
This 2021 AUA guideline provides a framework for individualised counselling and for choosing between partial nephrectomy, radical nephrectomy and thermal ablation, and emphasises the priority of partial nephrectomy for T1a tumours and reducing overuse of radical nephrectomy. The role of renal mass biopsy and the genetic counselling recommendations have also been updated. The current status of this guideline and any later updates should be checked in official AUA sources.
Limitations
The abstract does not give the text of the recommendations, the strength of evidence grade of each recommendation or the exact thresholds of the criteria for radical nephrectomy; the full guideline must be consulted for these details. Active surveillance and post-intervention follow-up are covered in the companion paper (Part II).
This summary was prepared by the editorial team from the published paper; the original paper is the final reference. Read the original abstract on PubMed.