Campbell Steven C, Flanigan Robert C, Clark Joseph I
Department of Urology, The Cardinal Bernardin Cancer Center, Loyola University Medical Center, Hines VA Hospital, 2160 South 1st Avenue, Building 54, Room 237, Maywood, IL 60153, USA.
Curr Treat Options Oncol. 2003 Oct;4(5):363-72. doi: 10.1007/s11864-003-0037-4.
Patients presenting with metastatic renal cell carcinoma (RCC) face a dismal prognosis, with a median survival time of only 6 to 12 months and a 2-year survival rate of 10% to 20%. RCC is notoriously chemorefractory, and immunotherapy is associated with total response rates of less than 20% and complete response rates of less than 5%. Therefore, surgery has continued to play a prominent role in the management of patients with metastatic RCC. Recent randomized prospective trials suggest a survival advantage for cytoreductive nephrectomy, and some patients with advanced RCC may also achieve palliation. Patients with limited and resectable metastases should be considered for combined nephrectomy and metastasectomy. The other main option for patients with advanced RCC is systemic immunotherapy followed by assessment for surgical consolidation, but responses in the primary tumor are uncommon and results with this pathway have not been encouraging. Tumor embolization can be a valuable palliative adjunct for some patients with metastatic RCC. Cytoreductive nephrectomy represents the most aggressive pathway for patients with metastatic RCC. Although cytoreductive nephrectomy can extend survival by approximately 50% for many patients, it can be associated with morbidity and delay in administration of systemic therapy. Therefore, patient selection, taking into account performance status and sites and burden of disease, which are well-established prognostic factors for patients with metastatic RCC, is of paramount importance in managing this challenging group of patients.
转移性肾细胞癌（RCC）患者预后不佳，中位生存时间仅为6至12个月，2年生存率为10%至20%。众所周知，RCC对化疗耐药，免疫治疗的总缓解率低于20%，完全缓解率低于5%。因此，手术在转移性RCC患者的治疗中继续发挥着重要作用。最近的随机前瞻性试验表明，减瘤性肾切除术具有生存优势，一些晚期RCC患者也可能实现姑息治疗。对于转移灶局限且可切除的患者，应考虑联合肾切除术和转移灶切除术。晚期RCC患者的另一个主要选择是全身免疫治疗，然后评估是否进行手术巩固，但原发肿瘤的缓解并不常见，这种治疗途径的效果也不令人鼓舞。对于一些转移性RCC患者，肿瘤栓塞可以是一种有价值的姑息辅助治疗。减瘤性肾切除术是转移性RCC患者最激进的治疗途径。虽然减瘤性肾切除术可以使许多患者的生存期延长约50%，但它可能与发病率增加和全身治疗延迟有关。因此，在管理这一具有挑战性的患者群体时，考虑到体能状态、疾病部位和负担（这些是转移性RCC患者公认的预后因素）进行患者选择至关重要。
