Department of Urology, University Medical Centre Mannheim, Mannheim, Germany.
Glickman Urological and Kidney Institute, Department of Urology, Cleveland Clinic, Cleveland, OH, USA.
Eur Urol Oncol. 2018 Dec;1(6):512-523. doi: 10.1016/j.euo.2018.06.007. Epub 2018 Jul 13.
Management of locally recurrent renal cancer is complex.
In this systematic review we analyse the available literature on the management of local renal cancer recurrence.
A systematic search (PubMed, Web of Science, CINAHL, Clinical Trials, and Scopus) of English literature from 2000 to 2017 was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines.
The search identified 1838 articles. Of those, 36 were included in the evidence synthesis. The majority of the studies identified were retrospective and not controlled. Local recurrence after thermal ablation (TA) may be managed with repeat TA. Alternatively, salvage nephrectomy is possible. However, a higher rate of complications should be expected than after primary nephrectomy. Salvage nephrectomy and TA represent treatment options for local recurrence after partial nephrectomy. Local retroperitoneal recurrence after radical nephrectomy is ideally treated with surgical resection, for which minimally invasive approaches might be applicable to select patients. For large recurrences, addition of intraoperative radiation may improve local control. Local tumour destruction appears to be more beneficial than systemic therapy alone for local recurrences.
Management of local renal cancer relapse varies according to the clinical course and prior treatments. The available data are mainly limited to noncontrolled retrospective series. After nephron-sparing treatment, TA represents an effective treatment with low morbidity. For local recurrence after radical nephrectomy, the low-level evidence available suggests superiority of surgical excision relative to systemic therapy or best supportive care. As a consequence, surgery should be prioritised when feasible and applicable.
In renal cell cancer, the occurrence and management of local recurrence depend on the initial treatment. This cancer is a disease with a highly variable clinical course. After initial organ-sparing treatment, thermal ablation offers good cancer control and low rates of complications. For recurrence after radical nephrectomy, surgical excision seems to provide the best long-term cancer control and it is superior to medical therapy alone.
局部复发性肾细胞癌的治疗较为复杂。
本系统评价旨在分析局部肾细胞癌复发管理的相关文献。
按照系统评价和荟萃分析的首选报告项目的要求，对 2000 年至 2017 年的英文文献进行了系统检索（PubMed、Web of Science、CINAHL、ClinicalTrials 和 Scopus）。
检索共获得 1838 篇文献，其中 36 篇纳入证据综合。大多数研究为回顾性且未设对照。热消融（TA）后局部复发可选择重复 TA 或挽救性肾切除术。但后者的并发症发生率更高。部分肾切除术后局部复发可选择挽救性肾切除术或 TA。根治性肾切除术后局部腹膜后复发理想的治疗方法是手术切除，微创方法可能适用于部分患者。对于大的复发病灶，术中加用放疗可能会提高局部控制率。与全身治疗相比，局部肿瘤破坏似乎更有益于局部复发。
局部肾细胞癌复发的治疗取决于临床病程和既往治疗。目前的证据主要局限于非对照的回顾性研究。保肾治疗后，TA 是一种有效且并发症发生率低的治疗方法。根治性肾切除术后局部复发的治疗，目前的低级别证据表明手术切除优于全身治疗或最佳支持治疗。因此，在可行且适用的情况下，手术应作为优先选择。
在肾细胞癌中，局部复发的发生和治疗取决于初始治疗。这种癌症是一种临床表现差异较大的疾病。初始保肾治疗后，TA 能很好地控制肿瘤且并发症发生率低。根治性肾切除术后局部复发，手术切除似乎能提供最佳的长期肿瘤控制效果，优于单独的药物治疗。
