[局限性肾细胞癌的老年特异性]

Mongiat-Artus P, Paillaud E, Caillet P, Albrand G, Neuzillet Y

Inserm UMR_S1165, service d'urologie et unité de chirurgie et d'anesthésie ambulatoires, hôpital Saint-Louis, université Paris Diderot, université de Paris, Assistance publique-Hôpitaux de Paris, 75010 Paris, France.

EA 7376 épidémiologie clinique et vieillissement, service de gériatrie - unité d'onco-gériatrie et UCOG - Paris-Ouest, hôpital européen Georges-Pompidou, université René Descartes, université de Paris, Assistance publique-Hôpitaux de Paris, 75015 Paris, France.

Prog Urol. 2019 Nov;29(14):865-873. doi: 10.1016/j.purol.2019.08.281.

PURPOSE

To describe the epidemiology of renal cell carcinoma (RCC) and its natural history in the elderly patient. To propose adaptations of geriatric evaluation specific to RCC. Recall therapeutic options and the treatment options specific to elderly patients.

METHOD

Bibliographic research from the Medline bibliographic database (NLM Pubmed tool) and Embase, as well as on the websites of scientific societies of geriatrics, from the National Cancer Institute using the following keywords: elderly, geriatrics, renal cell carcinoma, small renal mass, diagnosis, treatment.

RESULTS

The incidence of RCC increases in France and peaks between 70 and 80 years. This increase in incidence is mainly due to the diagnosis of small renal masses (SMR). The specific mortality of RCC increases with age (at least between 75 and 95 years). Tumor biopsy, especially of SMR, should be considered in the elderly patient. The geriatric assessment of patients with CaR has no specificity apart from specific evaluation of renal function and operative risk. There is no prospective therapeutic trials dedicated to elderly patients with localized RCC. Surgical treatment requires the use of fast track protocol (the modalities of which are being elaborated) in which geriatricians play a key role throughout the process. The role of percutaneous ablative treatment should be better defined in elderly patients. However, given their low specific mortality, surveillance of SRM (at least initially) is probably an interesting option, certainly under-used, although its impact on quality of life remains to be clarified. The overarching goal of geriatric oncology must guide the decisions of care in the older patient with CaR: first, the respect of patient-specific expectations and secondly the search for an overall clinical benefit; objectives that have no reason to be restricted to elderly patients.

CONCLUSION

RCC is becoming a predominantly elderly cancer. It responds to the current general diagnostic and therapeutic guidelines. It is desirable that clinical research help to better define the respective roles of percutaneous biopsy and treatment of localized RCC.

目的

描述老年患者肾细胞癌（RCC）的流行病学及其自然病史。提出针对RCC的老年评估适应性措施。回顾治疗选择以及老年患者的特定治疗方案。

方法

通过医学文献数据库（NLM Pubmed工具）和Embase进行文献检索，并在老年医学科学协会网站、美国国立癌症研究所网站上使用以下关键词进行检索：老年人、老年医学、肾细胞癌、小肾肿块、诊断、治疗。

结果

在法国，RCC的发病率呈上升趋势，在70至80岁之间达到峰值。发病率的增加主要归因于小肾肿块（SMR）的诊断。RCC的特定死亡率随年龄增长而增加（至少在75至95岁之间）。老年患者应考虑进行肿瘤活检，尤其是对SMR的活检。除了对肾功能和手术风险进行特定评估外，对RCC患者的老年评估并无特异性。目前尚无专门针对老年局限性RCC患者的前瞻性治疗试验。手术治疗需要采用快速康复方案（其具体模式正在制定中），在此过程中，老年医学专家发挥关键作用。经皮消融治疗在老年患者中的作用应得到更好的界定。然而，鉴于其较低的特定死亡率，对SMR进行监测（至少在初始阶段）可能是一个有趣的选择，尽管其对生活质量的影响仍有待阐明，但这一选择肯定未得到充分利用。老年肿瘤学的总体目标必须指导对老年RCC患者的护理决策：首先，尊重患者的特定期望；其次，寻求总体临床获益；这些目标不应仅限于老年患者。