Mancini Vito, Battaglia Michele, Ditonno Pasquale, Palazzo Silvano, Lastilla Gaetano, Montironi Rodolfo, Bettocchi Carlo, Cavalcanti Elisabetta, Ranieri Elena, Selvaggi Francesco P
Department of Emergency and Organ Transplantation (D.E.T.O.), Urology and Kidney Transplantation Unit, University of Bari, Bari, Italy.
Urol Oncol. 2008 May-Jun;26(3):225-38. doi: 10.1016/j.urolonc.2007.05.017. Epub 2007 Dec 3.
In recent years molecular biologists and pathologists have described new entities of renal cell cancer (RCC) with a totally different morphology and biology among the histotypes of renal carcinoma, but always referring to the same renal cancer disease. The evidence of a distinct biological behavior and long-term prognosis among these makes the correct pathological diagnosis of renal cancer critically important for the clinician. Advances in understanding of the pathogenesis, behavior, and importance of prognostic factors for RCC have paved the way for a revision of its classification and staging. We reviewed the role of histological classification, microscopic tumor necrosis, microscopic venous invasion, lymph node involvement and, particularly, pathological stage. In our series of patients who underwent renal surgery for neoplasm, a retrospective study established the predictive role of tumor size on recurrence rate, compared with other known prognostic factors, and we conclude that histological grade, pathological stage and tumor size remain relevant prognosticators in early stage RCC patients. In order to optimize the management of patients with RCC it is necessary to develop an interdisciplinary approach (surgeon, radiologist, pathologist, oncologist) and find new prognostic parameters at molecular and cellular levels. Many efforts are ongoing to integrate molecular data (from tissue microarrays) and clinical data (traditional prognosticators) into a molecular integrated staging system. In the postgenomic era, new tumor-associated antigens and molecules can be identified at the protein level using proteomics, providing a major opportunity for screening and finding novel targets that are the basis of new emerging therapies for RCC.
近年来，分子生物学家和病理学家在肾癌组织类型中描述了具有完全不同形态和生物学特性的肾细胞癌（RCC）新实体，但它们都归属于同一种肾癌疾病。这些新实体具有独特的生物学行为和长期预后，这使得肾癌的正确病理诊断对临床医生至关重要。对RCC发病机制、行为及预后因素重要性的深入理解，为其分类和分期的修订铺平了道路。我们回顾了组织学分类、微观肿瘤坏死、微观静脉侵犯、淋巴结受累情况，特别是病理分期的作用。在我们这组因肿瘤接受肾手术的患者中，一项回顾性研究确定了与其他已知预后因素相比，肿瘤大小对复发率的预测作用，我们得出结论，组织学分级、病理分期和肿瘤大小在早期RCC患者中仍是相关的预后指标。为了优化RCC患者的管理，有必要开展多学科方法（外科医生、放射科医生、病理学家、肿瘤学家）并在分子和细胞水平上寻找新的预后参数。目前正在进行许多努力，将分子数据（来自组织微阵列）和临床数据（传统预后指标）整合到分子综合分期系统中。在后基因组时代，可使用蛋白质组学在蛋白质水平上鉴定新的肿瘤相关抗原和分子，这为筛查和寻找新靶点提供了重大机遇，而这些新靶点是RCC新兴治疗方法的基础。
