Department of Pathology and Molecular Pathology, University of Zurich and University Hospital Zurich.
Department of Medical Oncology and Haematology, University Hospital Zurich.
Curr Opin Urol. 2021 May 1;31(3):228-235. doi: 10.1097/MOU.0000000000000864.
The aim of this review is to outline characteristics of the renal cell carcinoma (RCC) tumor immune microenvironment (TIME), the potential impact of tumor intrinsic alterations on the TIME and the value of metastatic tissue assessment in this context.
According to the latest European Association of Urology, European Society for Medical Oncology and National Comprehensive Cancer Network guidelines immune checkpoint inhibition represents a new core treatment strategy in advanced clear cell RCC (ccRCC). Despite its success, the prognosis of many RCC patients remains unsatisfactory most likely because of resistance mechanisms within the TIME. Moreover, most studies assess the primary tumor even though the advanced metastatic disease is targeted. Overall, metastatic RCC has hardly been investigated. First insights into the complexity of the genomic and immune landscape in RCC were recently provided. The functional impact of tumor intrinsic alterations on the TIME has just been described potentially contributing to therapy response in RCC.
The complexity of the RCC TIME and its potential interdependence with tumor intrinsic alterations has only just been recognized. A deeper understanding of the TIME may reveal predictive and prognostic biomarkers long-awaited in RCC, improve RCC patient stratification and could possibly be most instructive if assessed in metastatic tissue.
目的综述：本文旨在概述肾细胞癌 (RCC) 肿瘤免疫微环境 (TIME) 的特征，肿瘤内在改变对 TIME 的潜在影响，以及在这种情况下转移性组织评估的价值。
最新发现：根据欧洲泌尿外科协会、欧洲肿瘤内科学会和美国国家综合癌症网络的最新指南，免疫检查点抑制是晚期透明细胞肾细胞癌 (ccRCC) 的一种新的核心治疗策略。尽管取得了成功，但许多 RCC 患者的预后仍然不尽如人意，这很可能是由于 TIME 中的耐药机制所致。此外，大多数研究评估的是原发肿瘤，尽管靶向的是晚期转移性疾病。总的来说，转移性 RCC 几乎没有被研究过。最近，人们对 RCC 中基因组和免疫景观的复杂性有了初步的了解。肿瘤内在改变对 TIME 的功能影响刚刚被描述出来，这可能有助于解释 RCC 的治疗反应。
总结：RCC TIME 的复杂性及其与肿瘤内在改变的潜在相关性才刚刚被认识到。对 TIME 的深入了解可能会揭示人们期待已久的预测和预后生物标志物，改善 RCC 患者的分层，如果在转移性组织中进行评估，可能会更具指导意义。
