Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, QC, Canada.
Eur Urol. 2011 Oct;60(4):644-61. doi: 10.1016/j.eururo.2011.06.041. Epub 2011 Jun 30.
The natural history of renal cell carcinoma (RCC) is highly unpredictable. Small renal masses may be accompanied by metastatic disease. Conversely, patients with locally advanced disease may enjoy long-term disease-free survival.
To review the status of prognostic factors in RCC.
A literature review was performed using the PubMed, MEDLINE, and Cochrane databases for articles published as of February 15, 2010. Electronic articles published ahead of print were also considered. Search was limited to the English language. Search was conducted using the following keywords: renal cell carcinoma, molecular, tissue, markers, blood, urine, progression, prognosis, risk factor, and survival. Studies were selected according to the relevance of the study, the number of patients included, originality, actuality, and clinical applicability of the results.
Four areas of prediction were examined: (1) new RCC diagnostics, (2) RCC grade and stage at diagnosis, (3) disease progression, and (4) disease-specific mortality. All identified reports represented either case series or controlled studies. Although a large number of markers were identified, only a few were validated. Several prognostic factors were integrated in predictive or prognostic models.
Several prognostic factors can help discriminate between favourable and unfavourable RCC phenotypes. Of those, several clinical, pathologic, and biologic markers have been tested and validated, and they are used in predictive and prognostic models. Nonetheless, the search continues, especially for informative markers predicting the response to targeted therapies.
肾细胞癌（RCC）的自然病程极难预测。小的肾肿瘤可能伴有转移病变。相反，局部进展性疾病的患者可能享有长期无病生存。
综述 RCC 预后因素的现状。
使用 PubMed、MEDLINE 和 Cochrane 数据库对截至 2010 年 2 月 15 日发表的文章进行文献复习。也考虑了预印本发表的电子文章。检索仅限于英文。使用以下关键词进行检索：肾细胞癌、分子、组织、标志物、血液、尿液、进展、预后、风险因素和生存。根据研究的相关性、纳入患者的数量、研究的原创性、时效性和结果的临床适用性选择研究。
考察了四个预测领域：（1）新的 RCC 诊断，（2）RCC 诊断时的分级和分期，（3）疾病进展，（4）疾病特异性死亡率。所有确定的报告都代表病例系列或对照研究。尽管已经确定了大量的标志物，但只有少数得到了验证。一些预后因素被整合到预测或预后模型中。
一些预后因素有助于区分有利和不利的 RCC 表型。其中，一些临床、病理和生物学标志物已经过测试和验证，并被用于预测和预后模型。尽管如此，仍在继续探索，特别是寻找有预测作用的信息标志物，以预测对靶向治疗的反应。
