Prophylactic selective arterial embolization for renal angiomyolipomas: efficacy and evaluation of predictive factors of significant shrinkage
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To evaluate the efficacy of prophylactic selective arterial embolization (SAE) of angiomyolipomas (AMLs) and to find out predictive factors of significant shrinkage of AMLs after SAE.
Patients receiving prophylactic SAE for renal AMLs with complete medical records were included. The changes of the size, urine erythrocyte counts, and serum creatinine of all patients pre- and post-embolization were assessed. Demographic data, symptoms, the background of tuberous sclerosis complex (TSC), aneurysms, enhancement features, initial tumor sizes, and serum creatinine pre-embolization were estimated as predictive factors of significant shrinkage in size.
Forty-five patients receiving prophylactic SAE for AMLs successfully in our center were included with median follow-up of 14.0 months (interquartile range 6.5–40.5). Mean size of AMLs decreased from 10.7 ± 6.2 to 8.3 ± 5.9 cm by 23.4% ± 20.6% at the latest follow-up (P < 0.001). Urine erythrocytes decreased significantly after SAE (11.1 [interquartile range 5.7–23.2] vs. 6.4 [interquartile range 2.7–13.4], P < 0.001). In addition, there was no significant change between the serum creatinine before and after embolization (81.8 ± 14.9 mmol/L vs. 83.6 ± 17.1 mmol/L, P = 0.224). Of the variables mentioned above, only the enhanced area of AMLs before SAE was statistically significant between the groups with and without significant shrinkage (P < 0.001). In multiv-ariate analysis, enhanced area < 25% (AOR = 0.015, 95% CI 0.001–0.367) and having the background of TSC (AOR = 0.056, 95% CI 0.004–0.799) were identified as predictive factors of significant shrinkage of the tumors.
Prophylactic SAE is effective in reducing the size of renal AMLs and decreasing urine erythrocytes with preservation of renal function. Significant shrinkage of AMLs after SAE is modulated by the enhanced area and the background of TSC.
KeywordsAngiomyolipoma Selective arterial embolization Kidney neoplasms Tuberous sclerosis
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
For this retrospective study, formal consent is not required.
Informed consent was obtained from all individual participants included in the study.
- 3.Konosu-Fukaya S, Nakamura Y, Fujishima F, Kasajima A, Takahashi Y, Joh K, Ikeda Y, Ioritani N, Watanabe M, Sasano H (2013) Bilateral papillary renal cell carcinoma and angiomyolipoma in the patients with autosomal dominant polycystic kidney disease: case report of two cases and literature review. Pol J Pathol 64:303–307CrossRefPubMedGoogle Scholar
- 6.Sun P, Liu J, Charles H, Hulbert J, Bissler J (2017) Outcomes of angioembolization and nephrectomy for renal angiomyolipoma associated with tuberous sclerosis complex: a real-world US national study. Curr Med Res Opin 33:821–827. https://doi.org/10.1080/03007995.2017.1286307 CrossRefPubMedGoogle Scholar
- 8.Hocquelet A, Cornelis F, Le Bras Y, Meyer M, Tricaud E, Lasserre AS, Ferriere JM, Robert G, Grenier N (2014) Long-term results of preventive embolization of renal angiomyolipomas: evaluation of predictive factors of volume decrease. Eur Radiol 24:1785–1793. https://doi.org/10.1007/s00330-014-3244-4 CrossRefPubMedGoogle Scholar
- 9.Han YM, Kim JK, Roh BS, Song HY, Lee JM, Lee YH, Lee SY, Chung GH, Kim CS, Sohn MH, Choi KC (1997) Renal angiomyolipoma: selective arterial embolization–effectiveness and changes in angiomyogenic components in long-term follow-up. Radiology 204:65–70. https://doi.org/10.1148/radiology.204.1.9205224 CrossRefPubMedGoogle Scholar
- 11.Eisenhauer EA, Therasse P, Bogaerts J, Schwartz LH, Sargent D, Ford R, Dancey J, Arbuck S, Gwyther S, Mooney M, Rubinstein L, Shankar L, Dodd L, Kaplan R, Lacombe D, Verweij J (2009) New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer 45:228–247. https://doi.org/10.1016/j.ejca.2008.10.026 CrossRefPubMedGoogle Scholar
- 15.Bardin F, Chevallier O, Bertaut A, Delorme E, Moulin M, Pottecher P, Di Marco L, Gehin S, Mourey E, Cormier L, Mousson C, Midulla M, Loffroy R (2017) Selective arterial embolization of symptomatic and asymptomatic renal angiomyolipomas: a retrospective study of safety, outcomes and tumor size reduction. Quant Imaging Med Surg 7:8–23. https://doi.org/10.21037/qims.2017.01.02 CrossRefPubMedPubMedCentralGoogle Scholar
- 18.Planche O, Correas JM, Mader B, Joly D, Mejean A, Helenon O (2011) Prophylactic embolization of renal angiomyolipomas: evaluation of therapeutic response using CT 3D volume calculation and density histograms. J Vasc Interv Radiol 22:1388–1395. https://doi.org/10.1016/j.jvir.2011.05.016 CrossRefPubMedGoogle Scholar