Schostak Martin
Klinik für Urologie und Kinderurologie, Universitätsklinikum Magdeburg A.ö.R., Leipziger Str. 44, 39120, Magdeburg, Deutschland.
Urologe A. 2017 May;56(5):610-616. doi: 10.1007/s00120-017-0363-y.
Primary tumor resection in patients with synchronous metastatic renal cell carcinoma and a good performance status corresponds to a guideline recommendation which, however, is based on weak data from the era of cytokine therapy. This article presents arguments that weigh heavily against cytoreductive nephrectomy. From a molecular genetic viewpoint, the intervention eliminates only the easiest adversary but cannot prevent cancer-related death. Therefore, benefits and risks must be carefully and critically considered. Cytoreductive nephrectomy is not beneficial if treatment-induced morbidity will substantially affect the patient's quality of life and/or life expectancy or if the size and topography of the primary tumor renders it less dangerous than the metastases.
对于同时性转移性肾细胞癌且身体状况良好的患者，进行原发肿瘤切除符合一项指南推荐，然而，该推荐基于细胞因子治疗时代的薄弱数据。本文提出了强烈反对减瘤性肾切除术的观点。从分子遗传学角度来看，该干预措施仅消除了最容易对付的对手，但无法预防癌症相关死亡。因此，必须仔细且审慎地权衡利弊。如果治疗引起的并发症将严重影响患者的生活质量和/或预期寿命，或者如果原发肿瘤的大小和位置使其比转移灶危险性更低，那么减瘤性肾切除术并无益处。
