Department of Urology, University Hospital Henri Mondor, APHP, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France.
Biomaps, UMR1281, INSERM, CNRS, CEA, Université Paris Saclay, Villejuif, France.
World J Urol. 2021 Aug;39(8):2831-2841. doi: 10.1007/s00345-021-03632-6. Epub 2021 Feb 22.
Renal cell carcinoma (RCC) incidence has considerably increased during the last decades without any real impact on age-standardized mortality. It questions the relevance of aggressive treatments carrying potential side effects. Conservative management should be considered for frail patients. Comorbidity and frailty assessment in RCC patients is paramount before engaging a treatment.
Narrative, non-systematic review based on PubMed and EMBASE search with the terms "renal neoplasm", "elderly, frail", "comorbidities", "active surveillance", "metastatic". The selection was restricted to articles written in English.
Comorbidity and frailty assessment go along with the cancer-specific aggressivity and intervention risks assessment. In localized disease, several standardized algorithms offer patient health evaluation to define how suitable the patient would be for curative treatment. The pre-operative American Society of Anesthesiologists and the age-adjusted Charlson's scores are the most widely used. At the metastatic stage, drug combinations based on immunotherapies and targeted therapies improved cancer outcomes at the price of significant toxicities. Frail patients are not always suitable for such strategies. Commonly used scores like the International Metastatic RCC Database Consortium or Memorial Sloan Kettering Cancer Center integrate features to define patients' risk groups, more specifically the Karnofsky Performance Score is an easy way to document the frailty.
Comorbidity and frailty have to be assessed at any stage of the RCC disease based on a standardized scoring system to define the most suitable treatment strategy ranging from surveillance to aggressive treatment.
在过去几十年中，肾细胞癌（RCC）的发病率显著增加，但在标准化死亡率方面并没有实质性的影响。这使得激进的治疗方法（可能会带来副作用）的有效性受到质疑。对于虚弱的患者，应考虑保守治疗。在开始治疗之前，应评估 RCC 患者的合并症和虚弱情况。
基于 PubMed 和 EMBASE 搜索的非系统性综述，使用了“肾肿瘤”、“老年人，虚弱”、“合并症”、“主动监测”、“转移性”等术语。选择仅限于用英语撰写的文章。
合并症和虚弱评估与癌症特异性侵袭性和干预风险评估相关。在局限性疾病中，有几种标准化算法可以评估患者的健康状况，以确定患者是否适合进行根治性治疗。最常用的是术前美国麻醉医师协会（ASA）评分和年龄调整后的 Charlson 评分。在转移性阶段，基于免疫疗法和靶向治疗的药物联合治疗改善了癌症预后，但毒性也显著增加。虚弱的患者并不总是适合这些策略。常用的评分系统，如国际转移性肾细胞癌数据库联盟（IMDC）或纪念斯隆凯特琳癌症中心（MSKCC），整合了一些特征来定义患者的风险组，更具体地说，卡诺夫斯基表现评分（KPS）是一种记录虚弱程度的简单方法。
应根据标准化评分系统评估 RCC 疾病的任何阶段的合并症和虚弱情况，以确定最合适的治疗策略，范围从监测到积极治疗。
