Mulders Peter, Bleumer Ivar, Oosterwijk Egbert
Department of Urology, University Medical Center Nijmegen, Geert Grooteplein 10, 6500 HB Nijmegen, The Netherlands.
Urol Clin North Am. 2003 Aug;30(3):455-65. doi: 10.1016/s0094-0143(03)00024-7.
Tumor markers are mainly used to diagnose specific malignancies. The methods commonly involve immunohistochemistry and cytogenetics, including FISH and RT-PCR. In RCC, the investigated tumor markers (summarized in Table 1) show additional prognostic value over classical prognostic factors such as stage and grade. These markers can be used for better patient selection, a more accurate individualization of treatment, and improved follow-up. Nevertheless, their definitive value must be reconfirmed in larger patient cohorts. Ultimately, these factors should be shown to be of value in a prospective well-controlled trial. One of the most promising new techniques involves gene expression profiling of solid tumors. This cDNA microarray technique applied in RCC has improved understanding of the molecular mechanism of the underlying tumor genesis and its correlation to the clinical course. Tumor antigens that are specific for RCC (eg, G250) and that induce a specific immune response can be used for vaccine treatment modalities. With the use of dendritic cells, antigen presentation can be improved. Several phase I studies are currently underway. More research is needed to obtain better antigens and markers in RCC to improve insight into the molecular mechanism of the development of RCC, to improve the selection of patients for treatment, and to increase its effectiveness.
肿瘤标志物主要用于诊断特定的恶性肿瘤。常用方法包括免疫组织化学和细胞遗传学，其中包括荧光原位杂交（FISH）和逆转录聚合酶链反应（RT-PCR）。在肾细胞癌（RCC）中，所研究的肿瘤标志物（总结于表1）显示出比诸如分期和分级等经典预后因素更高的预后价值。这些标志物可用于更好地选择患者、更准确地进行个体化治疗以及改善随访。然而，它们的确切价值必须在更大的患者队列中重新得到证实。最终，这些因素应在一项前瞻性的严格对照试验中证明其价值。最有前景的新技术之一涉及实体瘤的基因表达谱分析。应用于肾细胞癌的这种cDNA微阵列技术增进了对潜在肿瘤发生分子机制及其与临床病程相关性的理解。对肾细胞癌具有特异性（例如G250）并能诱导特异性免疫反应的肿瘤抗原可用于疫苗治疗模式。通过使用树突状细胞，可以改善抗原呈递。目前正在进行几项I期研究。需要开展更多研究以获得更好的肾细胞癌抗原和标志物，从而增进对肾细胞癌发生发展分子机制的认识，改善治疗患者的选择，并提高其有效性。
