Department of Surgery, Fox Chase Cancer Center, Temple University School of Medicine, 333 Cottman Avenue, Philadelphia, PA 19111, USA.
Med Clin North Am. 2011 Jan;95(1):179-89. doi: 10.1016/j.mcna.2010.08.021.
The evaluation and management of renal cell carcinoma (RCC) has evolved in recent decades in response to the changing clinical presentation of the disease. Traditional teaching suggested that RCC usually presents with signs or symptoms. However, RCC discovered this way was usually locally advanced and often metastatic, requiring radical nephrectomy in most cases but often having a poor prognosis. As contemporary general medical practice began routinely using axial body imaging in the evaluation of many nonspecific abdominal complaints, today more than 70% of RCC cases identified are "screen-detected" as incidental findings having no attributable symptoms. This change has prompted a significant RCC stage migration over the past 20 years, with most kidney tumors seen in 2010 being smaller, organ-confined, and appropriate for nephron-sparing approaches with the anticipation of a favorable outcome. The approach to addressing patients with these incidentally detected, often localized, small renal masses raises different concerns than those for traditional patients presenting with symptomatic RCC. This article reviews the modern epidemiology of RCC, outlines the components of the evaluation of the incidental renal mass, details the current options of management, and discusses the long-term expectations for these patients.
近几十年来，肾细胞癌 (RCC) 的评估和管理发生了变化，以应对疾病临床表现的变化。传统的教学认为 RCC 通常表现为体征或症状。然而，以这种方式发现的 RCC 通常已经局部进展，并且经常发生转移，大多数情况下需要根治性肾切除术，但往往预后不良。随着当代普通医学实践开始在许多非特异性腹部不适的评估中常规使用轴向身体成像，如今超过 70%的 RCC 病例是作为无明显症状的偶然发现而“筛查发现”的。这种变化促使过去 20 年来 RCC 分期发生了显著迁移，2010 年看到的大多数肾肿瘤体积更小、器官受限，适合保留肾单位的方法，预计结果良好。对于这些偶然发现的、通常局限于局部的小肾肿块的患者的处理方法与传统的有症状 RCC 患者的处理方法不同。本文综述了 RCC 的现代流行病学，概述了偶然发现的肾脏肿块评估的组成部分，详细介绍了当前的治疗选择，并讨论了这些患者的长期预期。
