Robles J E, Rosell D, Zudaire J J, Berián J M
Departamento de Urología, Clínica Universitaria, Facultad de Medicina, Universidad de Navarra.
Rev Med Univ Navarra. 1999 Apr-Jun;43(2):68-76.
Renal cell carcinoma is responsible for about 2% of all cancer deaths in developed countries and represents 80-85% of all tumors of the kidney. Its etiology is still largely undefined. Its incidence varies among countries, with the highest rates in North Americans and Scandinavians. Its incidence is steadily rising in the last ten years. The location of the tumor suppressor gene on chromosome 3p has contributed to the understanding of tumor pathogenesis. Renal cell carcinoma occurs nearly twice as often in men as in women. Patients are generally more than 40 years old at diagnosis, usually in the fifth to seventh decade of life. This tumor is more common among urban than rural residents, but it was not a consistent association with education or socio-economic status. Recently large epidemiologic studies showed an increased risk of renal-cell cancer in relation to tobacco smoking, with a relative risk of about 2 for current smokers. Other established risk factors are elevated body mass index (mainly in women) and a family history of the disease. Occupational exposure to chemicals appears to have little significance, although associations with specific products, such as asbestos fibres, have been reported. Some relationship has been observed between renal-cell cancer and hypertension, use of anti-hypertensives and kidney diseases, although this issue remains open to discussion. Data are inconsistent on the role of nutrition, mainly for fats and proteins, while vegetable and fruit consumption seems to convey some protection on renal-cell cancer risk. The risk of renal-cell cancer was not materially elevated in relation to coffee, tea and alcohol intake and, in women, oral contraceptive use, hormone replacement therapy, and menstrual factors.
在发达国家，肾细胞癌约占所有癌症死亡病例的2%，占肾脏所有肿瘤的80 - 85%。其病因在很大程度上仍不明确。其发病率在各国之间有所不同，北美人和斯堪的纳维亚人的发病率最高。在过去十年中，其发病率呈稳步上升趋势。位于3号染色体上的肿瘤抑制基因的定位有助于理解肿瘤的发病机制。肾细胞癌在男性中的发病率几乎是女性的两倍。患者确诊时通常年龄超过40岁，多在人生的第五至第七个十年。这种肿瘤在城市居民中比农村居民中更常见，但与教育程度或社会经济地位并无一致的关联。最近的大型流行病学研究表明，吸烟会增加患肾细胞癌的风险，当前吸烟者的相对风险约为2。其他已确定的风险因素包括体重指数升高（主要在女性中）和该病的家族病史。职业接触化学物质似乎意义不大，尽管有报告称与某些特定产品（如石棉纤维）有关联。肾细胞癌与高血压、使用抗高血压药物和肾脏疾病之间已观察到一些关系，尽管这个问题仍有待讨论。关于营养（主要是脂肪和蛋白质）的作用数据并不一致，而食用蔬菜和水果似乎对肾细胞癌风险有一定的保护作用。肾细胞癌的风险与咖啡、茶和酒精的摄入量以及女性使用口服避孕药、激素替代疗法和月经因素并无实质性升高。
