Erkkilä Kaisa, Tornberg Sara V, Järvinen Petrus, Järvinen Riikka, Kilpeläinen Tuomas P, Visapää Harri, Hervonen Petteri, Taari Kimmo, Nisen Harry
Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland,
Urol Int. 2019;102(4):390-398. doi: 10.1159/000494363. Epub 2019 Jan 11.
There is a lack of detailed population-based data for renal cell carcinoma (RCC).
The study aimed to examine the contemporary changes in the clinical picture and treatment of RCC.
A total of 1,719 consecutive patients living in the Helsinki metropolitan area with a solid or cystic renal mass (Bosniak 3-4) ≥10 mm were identified. Data from medical records was evaluated for clinical characteristics and treatments in the periods I (2006-2008), II (2009-2011), III (2012-2014), and IV (2015-2016).
The proportions of patients with comorbidities (Charlson index ≥2) and frailty (Eastern Co-operative Oncology Group classification ≥2) increased significantly during the study period. The percentage of clinical stage I patients, cystic tumors and use of needle biopsies increased significantly. Use of observation increased from 9% (I) to 32% (IV; p < 0.001). First-line oncological treatments within 6 months were given to 47% of 262 patients with metastases and -cytoreductive nephrectomy (CN) was delivered to 54% of those patients.
The size of renal tumors continued to decrease, while the percentage of patients with significant comorbidity or frailty increased. Active surveillance emerged as the initial strategy. Tyrosine kinase inhibitors with CN remained the primary option in patients with metastatic RCC.
肾细胞癌（RCC）缺乏基于人群的详细数据。
本研究旨在探讨RCC临床表现和治疗的当代变化。
共纳入1719例居住在赫尔辛基大都市地区、患有实性或囊性肾肿块（Bosniak 3 - 4级）且直径≥10 mm的连续患者。评估了I期（2006 - 2008年）、II期（2009 - 2011年）、III期（2012 - 2014年）和IV期（2015 - 2016年）病历中的临床特征和治疗数据。
在研究期间，合并症（Charlson指数≥2）和虚弱（东部肿瘤协作组分类≥2）患者的比例显著增加。临床I期患者、囊性肿瘤和穿刺活检的使用比例显著增加。观察的使用比例从9%（I期）增加到32%（IV期；p < 0.001）。262例有转移的患者中，47%在6个月内接受了一线肿瘤治疗，其中54%的患者接受了减瘤性肾切除术（CN）。
肾肿瘤大小持续减小，而有显著合并症或虚弱的患者比例增加。主动监测成为初始策略。对于转移性RCC患者，酪氨酸激酶抑制剂联合CN仍然是主要选择。
