Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD 20892-7240, USA.
Nat Rev Urol. 2010 May;7(5):245-57. doi: 10.1038/nrurol.2010.46.
After more than two decades of rising rates, in recent years the total kidney cancer incidence worldwide has shown signs of stabilizing, or even decreasing. In adults, kidney cancer consists of renal cell carcinoma (RCC), the predominant form, and renal transitional cell carcinoma (RTCC); these types primarily arise in the renal parenchyma and renal pelvis, respectively. Although temporal trends by kidney cancer type are not well established worldwide, incidence of RCC in the US has continued to rise, mainly for early-stage tumors, while that of RTCC has declined, and total kidney cancer mortality rates have leveled. Stabilization of kidney cancer mortality rates has also been reported in Europe. These trends are consistent with reports of increasing incidental diagnoses and a downward shift in tumor stage and size in clinical series. The changing prevalence of known risk factors for RCC, including cigarette smoking, obesity, and hypertension, is also likely to affect incidence trends, although their relative impact may differ between populations. Accumulating evidence suggests an etiologic role in RCC for physical activity, alcohol consumption, occupational exposure to trichloroethylene, and high parity among women, but further research is needed into the potential causal effects of these factors. Genetic factors and their interaction with environmental exposures are believed to influence risk of developing RCC, but a limited number of studies using candidate-gene approaches have not produced conclusive results. Large consortium efforts employing genome-wide scanning technology are underway, which hold promise for novel discoveries in renal carcinogenesis.
在过去二十多年来发病率不断上升之后，近年来全球肾癌的总发病率已显示出稳定甚至下降的迹象。在成年人中，肾癌包括肾细胞癌（RCC），这是主要形式，和肾移行细胞癌（RTCC）；这些类型主要分别发生在肾实质和肾盂中。尽管全球范围内尚未明确确立肾癌类型的时间趋势，但美国的 RCC 发病率继续上升，主要是早期肿瘤，而 RTCC 的发病率则下降，肾癌总死亡率也趋于平稳。欧洲也有报道称肾癌死亡率趋于稳定。这些趋势与临床系列中偶然诊断的增加以及肿瘤分期和大小的下降一致。RCC 的已知危险因素（包括吸烟、肥胖和高血压）的流行率也可能会影响发病率趋势，尽管其相对影响在不同人群中可能不同。越来越多的证据表明，体力活动、饮酒、职业性接触三氯乙烯和女性生育次数较多与 RCC 的病因有关，但需要进一步研究这些因素的潜在因果效应。遗传因素及其与环境暴露的相互作用被认为会影响 RCC 的发病风险，但采用候选基因方法的少数研究并未得出明确的结果。正在进行使用全基因组扫描技术的大型联盟研究，这有望在肾发生癌方面取得新的发现。
