Renal cell carcinoma.
Renal cell carcinoma.
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DOI：
10.1136/bmj.g4797
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发表时间：
2014-11-10
期刊：
影响因子：
--
通讯作者：
Rathmell WK
中科院分区：
文献类型：
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作者：
Jonasch E;Gao J;Rathmell WK
过去 15 年来，肾细胞癌 (RCC) 的治疗发生了巨大变化。原发性肿瘤手术治疗的进展以及对该疾病的分子生物学和基因组学了解的加深导致了新治疗药物的开发。由于认识到原发性病变周围的干净边缘足以防止局部复发，以及更复杂的工具和技术的发展，提高了部分肾切除术的安全性，原发性肿瘤的治疗已经发生了变化。由于针对肿瘤脉管系统或减弱细胞内致癌途径激活的新药物的出现，晚期疾病的治疗发生了更加显着的变化。本综述总结了有关肾细胞癌手术治疗和全身治疗的前瞻性随机 III 期研究的数据，并提供了肾细胞癌的组织学、基因组学、分期和预后的最新总结。它描述了原发性肿瘤的治疗，并概述了构成晚期疾病治疗支柱的全身药物。该综述最后介绍了令人兴奋的新型免疫调节剂，这些药物目前正在进行临床试验，可能构成晚期肾细胞癌患者新治疗方法的基础。
The treatment of renal cell carcinoma (RCC) has changed greatly over the past 15 years. Progress in the surgical management of the primary tumor and increased understanding of the molecular biology and genomics of the disease have led to the development of new therapeutic agents. The management of the primary tumor has changed owing to the realization that clean margins around the primary lesion are sufficient to prevent local recurrence, as well as the development of more sophisticated tools and techniques that increase the safety of partial nephrectomy. The management of advanced disease has altered even more dramatically as a result of new agents that target the tumor vasculature or that attenuate the activation of intracellular oncogenic pathways. This review summarizes data from prospective randomized phase III studies on the surgical management and systemic treatment of RCC, and provides an up to date summary of the histology, genomics, staging, and prognosis of RCC. It describes the management of the primary tumor and offers an overview of systemic agents that form the mainstay of treatment for advanced disease. The review concludes with an introduction to the exciting new class of immunomodulatory agents that are currently in clinical trials and may form the basis of a new therapeutic approach for patients with advanced RCC.