Patel Hiren V, Srivastava Arnav, Singer Eric A
Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.
Med Res Arch. 2020 May;8(5). doi: 10.18103/mra.v8i5.2091. Epub 2020 May 25.
Lymph node involvement in renal cell carcinoma (RCC) correlates with poor oncologic outcomes. However, current RCC staging guidelines may not fully reflect the survival impact of lymph node positive disease. Recent data demonstrates that nodal disease has significant impact on survival and modifications to current staging guidelines have been proposed. Lymph node dissection (LND) at the time of surgical intervention for RCC remains controversial. While clinical trial data have demonstrated conflicting evidence for LND, some institutional studies suggests that carefully selected patients at high-risk for recurrence may benefit from LND. Prospectively, clinical trials are examining treating nodal disease and disease at high-risk of recurrence in the neoadjuvant and/or adjuvant setting at the time of nephrectomy. These promising trials are poised, if successful, to influence the treatment paradigm for localized RCC.
肾细胞癌（RCC）中的淋巴结受累与不良肿瘤学结局相关。然而，当前的RCC分期指南可能无法充分反映淋巴结阳性疾病对生存的影响。最近的数据表明，淋巴结疾病对生存有显著影响，并且有人提议对当前的分期指南进行修改。RCC手术干预时的淋巴结清扫术（LND）仍存在争议。虽然临床试验数据对LND的证据相互矛盾，但一些机构研究表明，精心挑选的高复发风险患者可能从LND中获益。前瞻性地，临床试验正在研究在肾切除术时在新辅助和/或辅助环境中治疗淋巴结疾病和高复发风险疾病。如果这些有前景的试验成功，有望影响局限性RCC的治疗模式。
