Burger M
Klinik für Urologie Lehrstuhl der Universität Regensburg, Caritas-Krankenhaus St. Josef, Landshuter Str. 65, 93053, Regensburg, Deutschland.
Urologe A. 2017 May;56(5):617-623. doi: 10.1007/s00120-017-0357-9.
Metastasis is a common event in renal cell carcinoma. Surgical resection of metastases may be feasible in two scenarios: aiming at palliation, which may be feasible due to reduced radiosensitivity of renal cell cancer, and aiming at prolonging survival, which may be feasible given the rather good prognosis of some patterns of metastasis.
This review intends to reflect on current evidence for surgical resection of metastases in both scenarios. The literature was searched in PubMed and respective guidelines were reviewed.
Palliative resection is mainly feasible to control symptoms like spinal compression; adjuvant radiation is advisable. Resection is markedly feasible, however, for improvement of cancer-specific survival in probably all resectable patterns of metastasis-solitary, multiple, syn- and metachronous, and in all organs-provided complete resection can be achieved. A fairly good prognosis is seen in solitary pulmonary metastasis without concomitant hilar or mediastinal lymph node metastasis and a metachronous appearance following long recurrence-free survival after tumor nephrectomy; complete resection may be considered curative in certain cases. Neo- or adjuvant medical therapy or radiation is not established. In cases lacking complete resectability, stereotactic radiation may be considered as an alternative.
转移是肾细胞癌的常见事件。转移灶的手术切除在两种情况下可能可行：一是旨在缓解症状，鉴于肾细胞癌对放疗的敏感性降低，这可能可行；二是旨在延长生存期，鉴于某些转移模式预后相对较好，这也可能可行。
本综述旨在思考上述两种情况下转移灶手术切除的现有证据。检索了PubMed中的文献并查阅了相关指南。
姑息性切除主要可行于控制如脊髓压迫等症状；辅助放疗是可取的。然而，对于可能所有可切除的转移模式——孤立性、多发性、同时性和异时性，以及在所有器官中——只要能实现完全切除，切除对于改善癌症特异性生存明显可行。在无肺门或纵隔淋巴结转移的孤立性肺转移以及肾肿瘤切除术后长期无复发生存后的异时性转移中，预后相当良好；在某些情况下，完全切除可被视为治愈性的。新辅助或辅助药物治疗或放疗尚未确立。在缺乏完全可切除性的情况下，立体定向放疗可被视为一种替代方法。
