Canda A Erdem, Kirkali Ziya
Manisa Sarigol State Hospital, Manisa, Turkey.
Urol J. 2006 Winter;3(1):1-14.
The aim of this review is to provide an update on the current management of renal cell carcinoma (RCC) and targeted molecular therapy for metastatic RCC.
A Pubmed database search was performed using the keywords "renal cell carcinoma, treatment, management, localized disease, metastatic disease and targeted therapy" covering 1995 to 2006. The most recent articles published having clinical relevance were reviewed for the preparation of this paper.
Surgery is considered as the only curative treatment for localized RCC. Currently, open radical nephrectomy is mainly performed in patients with large tumor size, locally advanced tumors and tumor thrombus extending into the vena cava. Nephron sparing surgery (NSS) is the most commonly performed procedure with excellent local cancer control in small, resectable renal tumors. Increasingly, laparoscopy is being performed and now recommended for early-stage RCCs unsuitable for NSS. Laparoscopic radical nephrectomy seems to be providing long-term cancer control comparable to open radical nephrectomy. Laparoscopic NSS is now available particularly in patients with a relatively small and peripheral renal tumor. The current therapy for metastatic RCC is inadequate and surgery is an important component of the treatment with combined immunotherapy in which response rates remain at about 15% to 25%. In the past several years, significant advances in the underlying biological mechanisms of RCC development have permitted the design of new molecularly targeted therapeutics such as antibodies, tumor vaccines, anti-angiogenesis agents and small molecule tyrosine kinase inhibitors in order to improve treatment options.
Surgery is the only curative treatment for localized RCC and NSS cures most of the patients with early-stage disease. Currently laparoscopy is recommended for early-stage RCCs unsuitable for NSS. Better understanding of the molecular pathways of carcinogenesis in RCC leads to the discovery of new drugs which can prolong survival in metastatic RCC.
本综述的目的是提供肾细胞癌（RCC）当前治疗及转移性RCC靶向分子治疗的最新情况。
使用关键词“肾细胞癌、治疗、管理、局限性疾病、转移性疾病和靶向治疗”对1995年至2006年的Pubmed数据库进行检索。为撰写本文，对发表的具有临床相关性的最新文章进行了综述。
手术被认为是局限性RCC的唯一治愈性治疗方法。目前，开放性根治性肾切除术主要用于肿瘤体积大、局部进展性肿瘤以及肿瘤血栓延伸至腔静脉的患者。保留肾单位手术（NSS）是最常施行的手术，对可切除的小肾肿瘤具有出色的局部癌症控制效果。越来越多地开展了腹腔镜手术，目前推荐用于不适合NSS的早期RCC。腹腔镜根治性肾切除术似乎能提供与开放性根治性肾切除术相当的长期癌症控制效果。腹腔镜NSS目前也可行，尤其适用于肾肿瘤相对较小且位于周边的患者。转移性RCC的当前治疗方法并不充分，手术是联合免疫治疗的重要组成部分，联合免疫治疗的缓解率仍维持在约15%至25%。在过去几年中，RCC发生的潜在生物学机制取得了重大进展，从而能够设计新的分子靶向治疗药物，如抗体、肿瘤疫苗、抗血管生成药物和小分子酪氨酸激酶抑制剂，以改善治疗选择。
手术是局限性RCC的唯一治愈性治疗方法，NSS可治愈大多数早期疾病患者。目前推荐对不适合NSS的早期RCC采用腹腔镜手术。对RCC致癌分子途径的更好理解促使发现了可延长转移性RCC患者生存期的新药。
