Prognostic factors in renal cell carcinoma
Prognostic factors in renal cell carcinoma
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DOI：
10.1007/s00345-010-0540-8
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发表时间：
2010-06-01
影响因子：
3.4
通讯作者：
Patard, Jean Jacques
中科院分区：
文献类型：
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作者：
Volpe, Alessandro;Patard, Jean Jacques
肾细胞癌（RCC）是一种异质性很强的疾病，预后差异很大.准确了解患者病情进展和治疗后死亡的个体风险对于指导患者、制定个体化监测方案、选择患者进行适应性治疗方案和新的临床试验至关重要（TNM分类，肿瘤大小），组织学（Fuhrman分级，组织学亚型），临床（症状和表现状态）和分子特征。所有这些功能在单独使用时都不完全准确。因此，越来越多的预后模型或列线图，包括几个组合的预后功能已被设计，以提高预测的准确性。UCLA综合分期系统（UISS）和马约诊所的SSIGN评分是两个最常用的局部RCC预后模型。在转移性肾细胞癌的背景下，经典的解剖学和组织学肿瘤特征几乎没有预测价值。然而，已经设计了准确的预后模型来预测对治疗的反应以及无进展生存期和总生存期。预测免疫治疗反应的两种最常用的工具是法国免疫治疗组设计的模型和Motzer模型。酪氨酸激酶抑制剂和抗血管生成药物的出现深刻地改变了转移性肾细胞癌的治疗。目前对局限性和转移性肾细胞癌的预后因素的认识越来越多，需要与现代靶向治疗相适应的预测工具。通过结合不同的预后特征，已经开发了几种预测模型，这些模型是患者咨询、治疗决策和试验设计的有价值的工具。需要进一步的研究来评估经典的预后因素与来自基因和蛋白质表达谱的分子特征和信息的组合是否可以增加当前预后模型的预测准确性。
Renal cell carcinoma (RCC) is a very heterogeneous disease with widely varying prognosis. An accurate knowledge of the individual risk of disease progression and mortality after treatment is essential to counsel patients, plan individualized surveillance protocols and select patients for adapted treatment schedules and new clinical trials.A systematic review of the literature on prognostic factors of localized and metastatic RCC was performed.Prognostic factors in RCC include anatomical (TNM classification, tumor size), histological (Fuhrman grade, histologic subtype), clinical (symptoms and performance status), and molecular features. All these features are not perfectly accurate when used alone. Therefore an increasing number of prognostic models or nomograms that include several combined prognostic features have been designed in order to improve predictive accuracy. UCLA Integrated Staging System (UISS) and the Mayo Clinic's SSIGN score are the two most used prognostic models for localized RCC. In the setting of metastatic RCC the classical anatomical and histological tumor features have little predictive value. However, accurate prognostic models have been designed to predict response to therapy, and progression-free and overall survival. The two most used tools to predict response to immunotherapy are the model designed by the French Group of Immunotherapy and the Motzer's model. The advent of tyrosine kinase inhibitors and antiangiogenic drugs have deeply changed the treatment of metastatic RCC. Predictive tools that are adapted to the modern targeted therapies are now needed.There is increasing knowledge on prognostic factors of localized and metastatic RCC. Several predictive models have been developed by combining different prognostic features and are valuable tools for patient counseling, treatment decision-making and trial design. Further research is needed to assess whether the combination of classical prognostic factors with molecular features and information from gene and protein expression profiling can increase the predictive accuracy of the current prognostic models.