Cella David
Department of Medical Social Sciences and The Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Evanston, IL, USA.
Cancer Treat Rev. 2009 Dec;35(8):733-7. doi: 10.1016/j.ctrv.2009.07.003. Epub 2009 Aug 21.
Renal cell carcinoma is the most common form of kidney cancer worldwide, and is associated with poor survival. Approximately a third of patients diagnosed with renal cell carcinoma present with metastatic disease and a further third experience recurrence following treatment for localized disease. Until recently, the cytokines interferon-alpha and interleukin-2 were the only effective treatments available for metastatic renal cell carcinoma and were associated with a modest increase in survival in a limited subset of patients. The prognosis for metastatic renal cell carcinoma has dramatically improved with the development of novel targeted agents including the oral tyrosine kinase inhibitors, sunitinib and sorafenib. However, renal cell carcinoma and the therapies used to treat patients with renal cell carcinoma are associated with a range of symptoms and treatment-related adverse events which contribute to the burden of disease. Common adverse events associated with targeted agents include fatigue, gastrointestinal and skin-associated toxicities. These adverse events, while mostly mild and manageable, affect the patients' health-related quality of life. As this review of the available quality of life data shows, assessment of the impact of the disease and its treatment on health-related quality of life may influence the choice of treatment and highlights the importance of incorporating patient-reported outcomes in clinical trials.
肾细胞癌是全球最常见的肾癌类型，且与生存率低相关。约三分之一被诊断为肾细胞癌的患者就诊时即有转移性疾病，另有三分之一在局部疾病治疗后出现复发。直到最近，细胞因子α干扰素和白细胞介素-2仍是转移性肾细胞癌仅有的有效治疗方法，且仅使有限部分患者的生存率适度提高。随着包括口服酪氨酸激酶抑制剂舒尼替尼和索拉非尼在内的新型靶向药物的研发，转移性肾细胞癌的预后有了显著改善。然而，肾细胞癌以及用于治疗肾细胞癌患者的疗法会引发一系列症状和与治疗相关的不良事件，这些都会加重疾病负担。与靶向药物相关的常见不良事件包括疲劳、胃肠道及皮肤相关毒性。这些不良事件虽然大多轻微且可控，但会影响患者与健康相关的生活质量。正如本次对现有生活质量数据的综述所示，评估疾病及其治疗对与健康相关生活质量的影响可能会影响治疗选择，并凸显了在临床试验中纳入患者报告结局的重要性。
